影响机械通气治疗肺透明膜病患儿疗效的因素分析

目的探讨机械通气治疗新生儿肺透明膜病(HMD)的预后及其影响因素。方法回顾2002年1月至2006年1月我院新生儿重症监护室经机械通气治疗的116例肺透明膜病病例,分析其疗效,对治愈组和死亡组的胎龄、体重、胸片分级、入院时肛温、血pH、有无使用肺表面活性物质(PS)、呼吸机参数、并发症等对比分析。结果机械通气治疗HMD的治愈率是86·2%,早期酸中毒、上机时高吸气峰压(PIP)及肺出血等严重并发症是死亡率增加的危险因素,而同时采用PS替代治疗可以明显提高治愈率。结论机械通气是治疗HMD的重要手段,同时采用PS治疗可以取得更好疗效,早期酸中毒及上机时高PIP提示疗效较差,积极防治并发症可改善疗效。

Analysis of factors affecting the outcome of ventilated neonates with hyaline membrane disease

Objective To study the outcome and its influencing factors of ventilated neonates with hyaline membrane disease (HMD). Methods One hundred and sixteen neonates ventilated for HMD in our NICU between January 2002 and January 2006 were studied. They were divided into group of survived and group of death. The following factors were compared and analyzed between the two groups: gestational age, birth weight, chest X-ray, rectal temperature at admission, blood pH, surfactant given or not, settings of ventilator and complications. Results The survival rate of neonates with HMD who were ventilated was 86.2%. The following factors could increase the risk of death: acidosis in early stage, high PIP when mechanical ventilation was initiated, pulmonary hemorrhage and other severe complications. When the neonates with HMD received surfactant, their survival rate could be increased significantly. Conclusions Mechanical ventilation plays an important role in the treatment of neonatal HMD. Administering surfactant with mechanical ventilation can improve the outcome. Acidosis in early stage and high PIP when mechanical ventilation is initiated are the signs of poor prognosis. Treating and preventing complications aggressively can improve HMD outcome.