1例新生儿胎粪吸入综合征合并肺动脉高压患儿的护理

正胎粪吸入综合征(meconium aspiration syndrome,MAS)或称为胎粪吸入性肺炎,是新生儿期特有的呼吸道疾病,主要是胎儿宫内窘迫或产时窒息排出胎粪污染羊水,宫内或产时吸入被胎粪污染的羊水引起呼吸道肺泡机械性阻塞和化学性炎症,多发于足月儿、过期产儿~([1])。如患儿生后缺氧持续存在或程度较重,可使肺血管阻力持续性增高,肺动脉压超过体循环动脉压,导致出生后持续的胎儿循环、血液通过动脉     

一例重症新生儿胎粪吸人综合征伴肺动脉高压的护理

胎粪吸人综合征（meconium aspiration syndrome,MAS）主要是胎儿在宫内或出生过程中吸入混有胎粪的羊水,引起呼吸道和肺泡机械性阻塞和化学性炎症,多发于足月儿、过期产儿,如患儿生后缺氧持续存在或程度较重,可使肺小动脉平滑肌增生或痉挛,导致出生后持续的胎儿循环、血液通过动脉导管和卵圆孔发生右向左分流,     

MAS伴新生儿窒息的抢救与防治

ＭＡＳ伴新生儿窒息的抢救与防治逄焕美，程茂玲２６６４００山东省胶南市第二人民医院山东省胶南市人民医院新生儿胎粪吸入综合征（ＭＡＳ）指胎儿在缺氧时吸入含粪的羊水，引起一系列气道阻塞症状。这类新生儿窒息者的预后较差，为降低死亡率，将我们对其抢救的措施报道...     

高频振荡通气联合肺表面活性物质联合治疗新生儿胎粪吸入综合征分析

目的对高频振荡通气联合肺表面活性物质联合用于新生儿胎粪吸入综合征的疗效进行分析。方法收取我院2016年8月～2018年2月收治的新生儿胎粪吸入综合征(MAS)患儿74例,随机分为参照组和观察组各37例,参照组行高频振荡通气,观察组在此基础上联合肺表面活性物质治疗,对两组治疗结果进行分析。结果观察组治疗后3、12、24h PaCO2低于参照组,差异有统计学意义(P0.05);观察组治疗后3、12、24h PaO2高于参照组,差异有统计学意义(P0.05);观察组治疗后3、12、24h OI低于参照组,差异有统计学意义(P0.05);观察组不良反应率为8.11%,参照组5.41%,差异不明显(P0.05)。结论高频振荡通气与肺表面活性物质联合用于新生儿胎粪吸入综合征治疗中效果显著,可改善其生命体征与氧合状态,且不会增加不良反应,安全性较高,值得应用。     

1例抢救溺水病人的护理体会

溺水者最严重的问题是换气不足，严重缺氧可由液体吸入或虽无液体吸入但因反射性喉痉挛引起的窒息所致。液体或颗粒性物质吸入可引起化学性肺炎，肺泡壁衬细胞受损及肺泡表面活性物质分泌受损，进而导致斑块状肺不张，无氧充入的肺不张区域可导致肺内血液分流，加重低血氧；随着吸入的液体增多，表面活性物质丧失加重，肺不张和低氧血症进一步加重。大区域的肺不张可导致肺僵硬而呼吸衰竭，可发生呼吸性酸中毒伴高碳酸血症，因组织缺氧又可导致同时存在的代谢性酸中毒。肺泡和组织的低氧可引起肺水肿和脑水肿，溺水所致的肺水肿被认为是肺泡低氧的直接后果，这与高海拔肺水肿类似，而不是心源性的，肺水肿和肺不张可同时存在。     

胎粪吸入综合征

胎粪吸入综合征简称 MAS 是胎儿在宫内或产时将有胎粪污染的羊水吸入呼吸道,娩出后出现呼吸道梗阻及换气障碍的一系列临床症状,是围生期新生儿主要死亡原因之一.一.病因及发病机理胎儿宫内缺氧时肠蠕动亢进,肛门括约肌松弛,胎粪即排入羊膜腔造成羊水污染,足月儿特别是过熟儿因自发性胃肠活动及迷走神经占优势,在宫内亦可有少量胎粪排出.因宫内缺氧使胎儿出现喘息样呼吸运动,可将胎粪吸入到气管分叉处,娩出后随     

高频震荡通气联合肺表面活性物质治疗重症胎粪吸入综合征的疗效

目的探讨高频震荡通气联合气管滴人肺表面活性物质（固尔苏）治疗重症胎粪吸人综合征（MAS）的疗效。方法将30例重症胎粪吸人综合征患儿按随机数字表法分为观察组和对照组,每组15例。对照组采用常频通气联合气管滴入肺表面活性物质治疗;观察组采用高频震荡通气联合气管滴入肺表面活性物质治疗。对2组患儿疗效,‰O：、p桕：,吸人氧浓度（FiO：）和氧合指数（OI）的变化,机械通气时间及住院时间进行比较。结果观察组机械通气时间及住院时间明显低于对照组（均P〈0．05）;随着治疗时间的增加,观察组的Pa02、Pa02／FiO2和0I均明显优于对照组f均P〈0．05）。结论高频震荡通气联合早期应用肺表面活性物质,能减轻炎症反应,有利于重症胎粪吸入综合征患儿的治疗。     

胎粪吸入综合征临床与胸片的关系

胎类吸入综合征(简称MAS)是胎儿在宫内将胎粪排入羊水中,并将含有胎粪的羊水吸入呼吸道造成呼吸道阻塞而引起的一系列缺氧症状,严重者可因呼吸衰竭而死亡。现将我院22例资料完整、诊断明确的病例分析如下。一、病例选择:①有羊水污染史。羊水呈黄色或绿色,质稀为轻度;羊水呈深(墨)绿色,质粘稠为重度。②有异常分娩史,出生时有窒息史。③呼吸困难,     

肺表面活性物质联合肺保护通气策略治疗新生儿重型胎粪吸入综合征合并急性肺损伤的疗效观察

目的探讨肺表面活性物质联合肺保护性通气策略治疗重症胎粪吸入综合征合并急性肺损伤新生儿的临床效果。方法选取50例重症胎粪吸入综合征合并急性肺损伤患儿,随机分成治疗组和对照组各25例。治疗组采取肺表面活性物质联合肺保护性通气策略,而对照组仅采取肺保护性通气策略治疗。比较通气前及通气2、12、24 h以及治疗后2组患儿的呼吸机相关指数、氧合指数、肺顺应性指标,同时比较2组患儿通气时间和住院时间。结果 (1)呼吸机相关参数比较,治疗组患儿吸入氧浓度24 h内显著下降,动脉血氧分压显著上升,平均气道分压也在24 h内迅速下降,2组比较有显著差异(P0.05)。(2)肺氧合指数比较上,治疗组患儿显著低于对照组患儿,在肺顺应性比较上,治疗组患儿显著高于对照组患儿。(3)治疗组患儿的通气时间和住院时间短于对照组患儿。讨论肺表面活性物质联合肺保护性通气策略对于治疗新生儿重型胎粪吸入综合征合并急性肺损伤的临床疗效优于单纯采用肺保护性通气策略。     

胎粪吸入综合征的治疗进展

胎粪吸入综合征（meconiumaspirationsyndrome,MAS）是指胎儿发生宫内窘迫或娩出时窒息排出胎粪污染羊水,被胎儿吸入引起气道阻塞,导致严重的呼吸困难引起全身症状的临床综合征。MAs以足月儿和过期产儿多见,病死率为4．2％～8．0％。MAS是造成新生儿期呼吸衰竭及死亡的主要疾病之一。胎粪吸人可致肺损伤、呼吸衰竭、持续肺动脉高压及各种气漏。现就MAS的治疗进展综述如下。     

Emergency Department Vacuum Extraction of an Obstructing Tracheal Foreign Body Using a Meconium Aspirator and Modified Endotracheal Tube

BackgroundA meconium aspirator is a simple plastic adapter that allows for rapid suctioning of the trachea when attached to an endotracheal tube and a source of continuous negative pressure, as was historically done for suspected neonatal meconium aspiration. Adaptation of this technique for the emergent vacuum extraction of an obstructing tracheal foreign body in an adult has not been previously described.Case ReportWe report the case of a 33-year-old woman with cardiorespiratory arrest after choking on food. Complete tracheal obstruction precluding oxygenation and ventilation due to aspirated chicken was diagnosed by emergency physicians and managed immediately with vacuum extraction using the technique described in this report. No additional airway interventions were necessary and the patient made a full neurologic recovery.Why Should an Emergency Physician Be Aware of This?Vacuum extraction using a meconium aspirator and modified endotracheal tube is a novel and potentially life-saving approach to the emergency management of airway obstruction after choking, especially if the foreign material is below the vocal cords and not amenable to manual extraction with a Magill forceps.     

胎粪吸入综合征患儿脑组织氧饱和度的监测及护理

目的探讨胎粪吸入综合征(MAS)患儿脑组织氧饱和度监测情况及相应的护理方法。方法将73例MAS患儿按病情分为两组,轻型38例为MASⅠ组,中、重型35例为MASⅡ组,应用无创组织氧监测仪对生后1、3、5、7 d的MAS患儿进行脑组织氧合状态的监测,并与正常新生儿进行比较。结果生后的1、3、5、7 d,正常新生儿与MASⅠ组和MASⅡ组患儿脑组织氧饱和度比较,MAS患儿的脑组织氧饱和度均有不同程度的降低。MASⅠ组患儿临床虽无明显缺氧症状及体征、肺部病变较轻,但与正常新生儿比较,出生后第3天的脑组织氧饱和度(rSO2)有显著性差异(P<0.01);MASⅡ组患儿生后的第1、第3、第5、第7天脑组织rSO2明显降低,与正常新生儿比较,各时相rSO2均有显著性差异(P<0.01)。结论MAS患儿脑组织rSO2受到不同程度的影响,缺氧的加重和持续时间增加可进一步加剧脑损伤,对MAS患儿应积极行呼吸道管理及加强护理,避免缺氧加重。采用近红外光谱测定技术对MAS的患儿进行动态监测,早期了解脑组织氧合状态,结合全身氧供需的变化,及时调整氧疗措施,对减轻缺氧脑损伤发生有重要的临床指导意义。     

Meconium aspiration syndrome. 1. Perinatal problems; etiology and types

Obstetric literature deals with meconium stained amniotic fluid (AF) in various ways when judging it as an indicator of fetal distress. This evidently reflects the difficulty of finding overt relations between measurable alterations in the condition of the fetus or of the newborn infant and the amount of meconium passed into the AF. Nor is the moment predictable by means of fetal monitoring when meconium is passed. Discussing these problems in the light of the consecutive course of events resulting finally in meconium aspiration some of the discrepancies can be explained without difficulty. Considering also the kinetics of formation and excretion of AF the distinction of 3 variants of meconium aspiration syndrome is possible: 1. late meconium aspiration syndrome in non-asphyctic infants, 2. late meconium aspiration syndrome in asphyctic infants, 3. "connatal" meconium aspiration syndrome.     

胎粪吸入综合征的临床及X线分析

目的：总结胎粪吸入综合征（MAS）的临床与X线特征，提高X线诊断水平。方法：对经临床证实的186例胎粪吸入综合征的临床X线资料进行回顾性分析，对其临床、病因、病理及X线诊断进行讨论。结果：根据X线表现，可将MAS分为轻度、中度及重度三类。轻度69例，中度103例，重度14例。186例中表现为气胸及纵隔气肿14例，合并肺部感染17例，过期产儿79例，2例死亡。结论：胸部摄片是诊断MAS的必不可少的手段。X线胸片是对MAS进行诊断、随访及疗效观察的一种最适宜的检查方法。     

Recent developments in care of the newborn

New developments in newborn care include body fluid precautions, especially the use of gloves and the use of mechanical suction instead of oral suction. Artificial surfactant is still investigational, but results to date are favorable. A recent report may lead to modification of practices for management of infants with possible meconium aspiration.     

新生儿胎粪吸入性肺炎的X线诊断

目的:探索X线诊断在新生儿胎粪吸入性肺炎中的应用.方法:回顾性分析2017年5月—2018年5月我院收治的20例胎粪吸入性肺炎患儿的胸部X线资料,进一步探讨新生儿胎粪吸入性肺炎的X线特征.结果:患儿X线多表现为不同程度的肺气肿,表现为散在性的斑片状及短条状边缘模糊的淡薄影,还会造成大叶性肺气肿,粗颗粒状结节阴影与两肺广...     

In utero distal pulmonary meconium aspiration.

We have recently had eight cases of severe meconium aspiration syndrome which occurred despite clearing of the posterior pharynx of meconium after delivery of the head but before delivery of the body. Seven of the eight cases had documented fetal distress before delivery. Two stillborns with meconium aspiration are presented and illustrate that electronic fetal monitoring and aggressive obstetric intervention should be coupled with the suctioning technic to prevent significant mortality and morbidity associated with meconium-stained deliveries.     

Use of the anterior cricoid split operation in infants with acquired subglottic stenosis

Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspiration of meconium and the other intubation for obstructive apnea. All had been extubated successfully in less than 2 wk and were discharged home with no signs of subglottic stenosis. These infants were referred at 2 to 13 months of age for evaluation of upper airway obstruction. By bronchoscopy, we confirmed severe subglottic stenosis in each of the infants. The anterior cricoid split procedure requires a single midline vertical incision through the anterior cartilaginous ring of the cricoid cartilage and the upper 2 tracheal rings. Our postoperative management included 7 to 10 days of endotracheal intubation, mechanical ventilation, neuromuscular blockade, sedation, and total parenteral nutrition. All were extubated at the end of this period without evidence of stridor or obstructive apnea. One patient developed a subglottic granuloma at the level of the cricoid cartilage 4 months after the operation; this was successfully excised with the carbon dioxide laser. The other 9 patients remain asymptomatic 1 month to 1 yr after the surgical repair.     

Tracheobronchial lavage--a supplementary measure in the initial management of meconium aspiration syndrome

Pulmonary lavage - a supplementary measure of resuscitation in newborn infants with severe aspiration of meconium stained amniotic fluid. During 1984-1985 150 mature newborn infants who had aspirated heavily-stained or pea soup-like amniotic fluid were resuscitated at the University Hospital of Obstetrics and Gynaecology in Graz. In 109 of these infants (controls) routine aspiration of both the upper and lower airways was accomplished as soon as possible, whilst in the remaining 41 infants (lavaged) pulmonary lavage with saline was additionally performed via an endotracheal tube after aspiration to clear the trachea and the upper bronchi from thick meconium which could not have been removed as efficiently otherwise. The incidence of manifest meconium aspiration syndrome was significantly higher (22%) in the lavaged infants than in the controls (8%). Mechanical ventilation was performed in 36% of the lavaged infants, whereas only 5.5% of the controls had to be ventilated for more than 1 hour. The mean duration of ventilation, however, was shorter (Mh = 5.1 hrs vs Mh = 69 hrs) and the average age at discharge lower in the lavaged. Three infants died, two of whom had severe malformations. Only one death in the lavaged infants was attributable to severe meconium aspiration syndrome already manifest at birth. Three infants (two lavaged, one control) showed radiological evidence of pneumothorax, but without clinical appearance of respiratory distress. Since the lavaged group naturally contained the more severely distressed infants, with a high incidence of caesarean section on account of intrauterine asphyxia and lower Apgar scores at one and five minutes, the high incidence of radiologically confirmed meconium aspiration syndrome was not surprising.(ABSTRACT TRUNCATED AT 250 WORDS)     

Failure to pass meconium: diagnosing neonatal intestinal obstruction

Timely passage of the first stool is a hallmark of the well-being of the newborn infant. Failure of a full-term newborn to pass meconium in the first 24 hours may signal intestinal obstruction. Lower intestinal obstruction may be associated with disorders such as Hirschsprung's disease, anorectal malformations, meconium plug syndrome, small left colon syndrome, hypoganglionosis, neuronal intestinal dysplasia and megacystis-microcolon-intestinal hypoperistalsis syndrome. Radiologic studies are usually required to make the diagnosis. In addition, specific tests such as pelvic magnetic resonance imaging, anorectal manometry and rectal biopsy are helpful in the evaluation of newborns with failure to pass meconium.