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目的 探索早期拔管改换无创通气策略治疗新生儿胎粪吸入综合征 (MAS)所致呼吸衰竭的技术可行性并评价其治疗效果。方法 2003年 1月至 2003年 10月北京朝阳医院儿科NICU选择接受气管插管机械通气的病例 12例为治疗组,待充分引流气道内胎粪后拔除气管插管,改用经鼻塞CPAP通气,直至脱离呼吸机;选择同样病情病例 13例为对照组,在引流气道内胎粪后继续按常规行有创机械通气,以SIMV+PEEP方式撤机。观察两组病例的临床转归情况。结果 治疗组与对照组的治疗前各指标相仿 (P>0 05);有创机械通气时间分别为(29 50±20 15)h和(51 08±22 64)h(P<0 05);发生呼吸机相关肺炎分别为 1例和 6例 (P<0 05);住ICU时间分别为(5 92±1 97)d和(9 00±2 83)d(P<0 01)。结论 对新生儿胎粪吸入综合征所致呼吸衰竭插管上机的病例,早期拔管,改用经鼻塞CPAP无创通气可以显著改善治疗效果。
Objective To explore the technical feasibility of early extubation in the treatment of respiratory failure caused by meconium aspiration syndrome (MAS) and to evaluate its curative effect by noninvasive ventilation. Methods From January 2003 to October 2003, 12 cases of mechanical ventilation of pediatric NICU of Chaoyang Hospital of Beijing were enrolled in the study. Twelve cases were treated by mechanical ventilation. After adequate removal of endotracheal intubation and removal of endotracheal intubation, Until out of the ventilator; select the same disease cases in 13 cases as the control group, after draining airway meconium continue to follow the conventional invasive mechanical ventilation, weaning by SIMV + PEEP. The clinical outcome of two groups was observed. Results The indexes before treatment in treatment group and control group were similar (P> 0.05). The time of mechanical ventilation was (29 50 ± 20 15) h and (51 08 ± 22 64) h respectively (P <0.05). Ventilator-associated pneumonia occurred in 1 and 6 patients, respectively (P <0 05). ICU duration was (5 92 ± 1 97) d and (9 00 ± 2 83) d, respectively (P 0 01). Conclusion In the neonatal case of respiratory failure due to meconium aspiration syndrome, early extubation and the use of non-invasive ventilation through nasal CPAP can significantly improve the therapeutic effect.