机械通气治疗肺透明病预后响因素分析机械通气治疗肺透明病预后影响因素分析.doc

机械通气治疗肺透明膜病预后影响因素分析 张春一 张小庄 罗先琼 杨杰 广州医学院附属妇儿医院 新生儿科 510010 [摘要] 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 回顾分析2002年1月～2006年1月我院NICU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PS治疗、呼吸机参数、并发症等对比分析，并进行预后多因素Logistic回归分析。结果 机械通气治疗HMD总的治愈率是86.2%，早期酸中毒和上机时高PIP是死亡率增加的危险因素(P 0.05)，而同时采用PS替代治疗可以明显提高治愈率（P0.05）。结论 机械通气是治疗HMD的重要手段，同时予以PS治疗可以取得更好疗效，早期酸中毒及上机时高PIP提示预后较差。 [关键词] 肺透明膜病；机械通气; 预后 [abstract] Object To evaluate the effect of mechanical ventilation therapy for neonatal hyaline membrane disease and factors associated with its prognosis. Methods 116 newborn infants with HMD who received mechanical ventilation from our NICU between Jan 2002 to Jan 2006 were analyzed(mean gestational age:31weeks and 5days, mean birth weight: 1731g).Comparisons of difference were made between the group of success and the group of death regarding the birth weight, the gestational age, the temperature on admission, blood pH levels before or at the time of treatment, imaging changes, PIP,PEEP,FiO2 of the ventilator and various complications. Then Logistic regression analysis was made. Results The success rate was 86.2% for neonates with HMD who were mechanically ventilated. Logistic regression analysis revealed that pH level before or at the time of treatment, the PIP level in need and PS admission were associated with prognosis(P0.05).There was no difference in gestational age, birth weight, imaging changes, temperature on admission，rate of complications between two groups. Conclusions Mechanical ventilation played an important role in the treatment of neonatal HMD. PS admission can improve the treatment effect while low pH level before or at the time of treatment and high PIP in need contribute to mortality rate. [Key words] hyaline membrane disease; mechanical ventilation; prognosis 新生儿肺透明膜病(hyaline membrane disease，HMD)是早产儿生后早期出现的以进行性呼吸困难为主要表现的呼吸系统疾病，在早产儿中有很高的发病率和病死率，是早产儿生后3 d 内死亡的首要原因。随着新生儿重症监护室的发展及肺表面活性物质、机械通气的广泛应用，早产儿抢救成功率明显提高。现将我院NICU应用机械通气治疗的116例肺透明膜病总结如下