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极重度支气管肺发育不良气管切开/家庭机械通气治疗2例病例报告
引用本文:李淑涓,曹云,程国强,张蓉,周建国,陈超,陈伟明,祁媛媛,唐子斐,钱丽清,孔维玲,蒋思远.极重度支气管肺发育不良气管切开/家庭机械通气治疗2例病例报告[J].中国循证儿科杂志,2021,16(4):262-268.
作者姓名:李淑涓  曹云  程国强  张蓉  周建国  陈超  陈伟明  祁媛媛  唐子斐  钱丽清  孔维玲  蒋思远
作者单位:复旦大学附属儿科医院上海,201102;1新生儿科,2 国家卫生健康委员会新生儿疾病重点实验室(复旦大学),3 耳鼻喉科头颈外科,4 重症医学科,5 呼吸科,6 消化科
摘    要:背景:气管切开/家庭机械通气治疗极重度支气管肺发育不良(sBPD)在中国尚未见报道。 目的:介绍2例sBPD患儿气管切开/家庭机械通气治疗经验。 设计:病例报告。 方法:报告2例sBPD患儿的临床特征、气管切开前评估、气管切开后从医院过渡至家庭辅助通气前的准备及出院后管理。 结果:2例早产儿因生后长时间(例1胎龄27+5周,生后7月19 d;例2胎龄24+6周,生后6月24 d)不能脱离有创呼吸支持转入复旦大学附属儿科医院,入院后从肺实质病变、气道病变、肺动脉高压角度细致评估sBPD表型,明确患儿存在严重气管、支气管软化伴肺实质病变。经多学科讨论明确患儿存在气管切开、长期家庭机械通气支持指征。充分与家属沟通并告知气管切开/长期机械通气的必要性和风险性后行气管切开术。在护理人接受家庭护理培训、各类环境/硬件准备、病房过渡等充分出院准备后,2例sBPD患儿成功过渡至家庭机械通气。 结论:气管切开/长期机械通气治疗为国内sBPD患儿提供了可能有效的长期通气解决方案,但需要多学科医疗团队和家庭护理人员长时间共同配合,仍存在成本、风险高,出院后管理体系未健全等诸多难点。

关 键 词:早产儿  极重度支气管肺发育不良  气管切开/家庭机械通气  
收稿时间:2021-05-17
修稿时间:2021-08-25

Two cases of severe bronchopulmonary dysplasia treated by tracheotomy and home mechanical ventilation:A case report
LI Shujuan,CAO Yun,CHENG Guoqiang,ZHANG Rong,ZHOU Jianguo,CHEN Chao,CHEN Weiming,QI Yuanyuan,TANG Zifei,QIAN Liqing,KONG Weiling,JIANG Siyuan.Two cases of severe bronchopulmonary dysplasia treated by tracheotomy and home mechanical ventilation:A case report[J].Chinese JOurnal of Evidence Based Pediatrics,2021,16(4):262-268.
Authors:LI Shujuan  CAO Yun  CHENG Guoqiang  ZHANG Rong  ZHOU Jianguo  CHEN Chao  CHEN Weiming  QI Yuanyuan  TANG Zifei  QIAN Liqing  KONG Weiling  JIANG Siyuan
Institution:Children's Hospital of Fudan University, Shanghai 201102, China; 1 Department of Neonatology, 2 Key Laboratory of Neonatal Diseases of the National Health Commission (Fudan University), 3 Department of Otorhinolaryngology, Head and Neck Surgery, 4 Department of Critical Care Medicine, 5 Department of Respiratory Medicine, 6 Department of Gastroenterology 
Abstract:Background: There has been no report on tracheotomy and home mechanical ventilation therapy for infants with severe bronchopulmonary dysplasia(BPD) in China. Objective: To describe the experience of two cases of severe BPD treated with tracheotomy and home mechanical ventilation therapeutic. Design: Case report. Methods: Clinical characteristics,multidisciplinary evaluation before tracheotomy,and transitional and postdischarge care of two infants with very severe BPD and home mechanical ventilation were reported. Results: Two premature infants were admitted for prolonged dependency of invasive mechanical ventilation (case 1: gestational age of 27+5weeks,7 months and 19 days after birth; case 2:gestational age of 24+6weeks,6 months and 24 days after birth).Evaluations on airway,lung parenchyma,and pulmonary vascular disease were performed,showing severe tracheobronchomalacia and severe heterogeneous lung parenchymal lesions.After multidisciplinary consultation and discussion,tracheotomy and long-term home mechanical ventilation support was indicated as the most suitable management strategy.The indication and risk of tracheotomy and long-term mechanical ventilation were discussed thoroughly with the parents.Tracheotomy was then performed.Both infants were discharged on home ventilators after careful assessment of coordination of postdsicharge care,readiness for home care,training of caregivers,and necessary equipment. Conclusion: Tracheotomy and long-term home mechanical ventilation treatment provided a possible treatment choice for ventilator-dependent severe BPD infants in China,but such treatment required significant efforts from the multidisciplinary medical team and family, and difficulties still remained such as cost, high risk,and postdischarge care.
Keywords:Premature infants  Extremely severe bronchopulmonary dysplasia  Tracheotomy/home mechanical ventilation  
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