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目的 探讨新的治疗技术如肺表面活性物质 (PS) ,鼻塞CPAP(NCPAP) ,以及开展新生儿转运对需机械通气的极低出生体重儿 (VLBWI)预后的影响。 方法 73例因呼吸衰竭、反复呼吸暂停、心肺复苏需机械通气的VLBWI按用新技术前后分为A组 3 2例 (1995～ 1998年 )和B组 41例(1999～ 2 0 0 2年 )。B组有 10例用PS(占 2 4% ) ,拔管后改用NCPAP 12例 (占 2 9% ) ,转运的患儿有11例 (占 2 7% )。 结果 两组比较 ,B组存活率明显提高 (3 9%与 71% ,P <0 .0 5) ;机械通气时间缩短 [(8.15± 11.57)d与 (4.59± 3 .50 )d(P <0 .0 5) ] ;院内感染发生率降低 (47%与 2 4% ,P <0 .0 5) ;低体温、代谢性酸中毒B组亦明显减少 ,而慢性肺疾病、颅内出血两组差异无显著性。 结论 VLB WI生后即予PS预防和治疗呼吸窘迫综合征 ;尽早撤离呼吸机 ,改用NCPAP ;开展新生儿转运 ,可能提高VLBWI机械通气的存活率 ,降低病死率
Objective To investigate the effects of new therapeutic techniques such as pulmonary surfactant (PS), nasal CPAP (NCPAP), and neonatal transit on the prognosis of VLBWI requiring mechanical ventilation. Methods Seventy - three cases of VLBWI with mechanical ventilation due to respiratory failure, repeated apnea and cardiopulmonary resuscitation were divided into two groups according to the new technique: 32 cases in group A (1995 ~ 1998) and 41 cases in group B (1999 ~ 2002) . In group B, 12 cases (12.9%) were treated with PS (24%), 12 cases were replaced by NCPAP after extubation, and 11 cases (27%) were transfered. Results The survival rate of group B was significantly higher than that of group B (39% vs 71%, P <0.05), and the duration of mechanical ventilation was shorter than that of group B (8.15 ± 11.57 days vs 4.59 ± 3.50 days (P < (P <0.05). The incidence of nosocomial infections was also decreased in both groups (47% vs 24%, P <0. 05), while hypothermia and metabolic acidosis in group B were also significantly reduced No significant difference. CONCLUSIONS: After VLB is born, PS can prevent and treat respiratory distress syndrome. As soon as possible, evacuation of ventilator can be replaced by NCPAP. Carrying out neonatal transport can increase the survival rate of VLBWI mechanical ventilation and reduce the mortality