机械通气治疗新生儿呼吸衰竭相关措施探讨

为探讨改进措施改善呼吸机治疗新生儿呼吸衰竭(简称呼衰)的预后,将经呼吸机治疗的265例呼衰分为3组,以1985年～1989年57例为甲组,1990年～1995年107例为乙组,1996年～2000年101例为两组作对比。3组的基本情况(性别、胎龄、入院体重、异常分娩史)比较,差异无显著性,P均>0.05。结果显示治愈率甲乙丙3组各为28.1％、52.3％和97.0％,病死率各为63.1％、17.8％和0％(x~2各为86.2,89.4,P均<0.01);在合并症中插管不当、肺气压伤、颅内出血、酸碱紊乱、肺不张、感染加重等,丙组的合并症明显低于甲、乙组,P均<0.01。丙组除做好呼吸管理外,加强对心、脑、肾、循环、胃肠功能受损的防治,使预后得以改善。

Clinical exploration on the managements of the mechanical ventilation in the treatment of newborn infants with acute respiratory failure

To explore the the management of the mechanical ventilation as well as its reduced incidence of complication and improved cure rate in the treatment of newborn infants with acute respiratory failure, 265 cases who stayed in NICU were divided into 3 groups according to the different periods of time. 57 cases in grap A were treated from 1985 to 1989 , 107 cases in group B from 1990 to 1995, and 101 cases in group C received modified managements from 1996 to 2000. In these 3 groups, there was of little difference in the clinical data, such as, sex gestation, birth weight and the history of abnormal labor. But the age in group B and C was younger than that in group A. In group C, 80 cases also accompanied with brain injury, 50 cases with heart failure, 31 cases with shock, 24 cases had renal failure, 6 cases had gastrointestinal dysfunction and 11 cases with hepatic failure.These results indicated: (1)The cure rate in group A, B and C were 28. 1%, 53.3% and 97.0% respectively. The individual mortality in these 3 groups was 63. 1%, 17.8% and 0%. The difference of the cure rate and mortality between group C and other 2 groups was of statistical significance (x2 =86. 2,89. 4, the P value in these groups<0.01). (2)The complications in these 3 groups were as follows:56. 1%, 17.8%,and 18.8% of the total cases had unsuitble intra-trachial intubations separately, 31.6%, 5.6% and 5.9% of cases had pulmonary barotraumas respectively, 28. 1%,9.3% and 3% cases had atelectasis separately, 43. 3% , 31. 8% and 17.8% cases had intracranial hemorrhage separately, 68.4%, 68.8% and 19.8% cases had acid-base imbalance respectively. In 46.1%, 23.5% and 13.3% cases, the pulmonary infections aggravated individually. There's significant difference in the incident of complication between group C and other 2 groups(both P value<0.01) .The x2 in these 3 groups was 33.0, 29.6 and 8.7 respectively (P value <0.05), indicating that incidence of this complications could happened as shown above. As a whole, the total incidence rate of the complications in group C was significantly lower than that in groups A and B, suggesting that it could be very important to improve the measures taken for treatment and prevention of the patients with heart, brain, kidney, circulation and gastrointestinal dysfunction. In addition to the improvement of the respiratory management as well as the prevention of the complications associated with the mechanical ventilator.Thus, improving the cure rate and lowering the mortality and morbidity should be significantly associated with the choice of using the mechanical ventilator.