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目的 探讨如何使用呼吸机对重症胎粪吸入综合征(MAS)进行合理治疗。方法 对近10年来我科NICU需机械通气的44例重症MAS患儿以1997年12月为界分为前期和后期两组,分析两组出生至上机时间、呼吸机使用时间、住院时间差异,比较两组持续肺动脉高压(PPHN)、缺氧缺血性脑病(HIE)、气胸、呼吸机相关性肺炎(VAP)、病死率。结果 前期组上机时间较后期组迟,两组分别为(31.5±7.2)h,(10.3±7.8)h;呼吸机使用时间分别为(145.0±26.4)h,(98.5±26.7)h;住院时间分别为(23.7±15.4)d,(14.4±6.0)d;均有非常显著差异,P<0.01。两组PPHN发生率分别为8例,3例;气胸分别为8例,4例;VAP分别为13例,9例,死亡分别为11例,7例,均有显著差异;HIE发生率分别为7例,5例;无显著差异;总体病死率40.9％。结论 对重症MAS患儿放宽上机指征,尽早上机,可大大缩短呼吸机使用时间和住院时间,减少并发症发生,降低病死率。
Objective To explore how to use ventilator to treat severe meconium aspiration syndrome (MAS). Methods 44 cases of severe MAS with NICU requiring mechanical ventilation in the past 10 years were divided into two groups at the first and second trimester in December 1997. The differences of birth to upper machine time, ventilator use time, hospitalization time, PPHN, HIE, pneumothorax, ventilator-associated pneumonia (VAP) and mortality were compared between the two groups. Results The time to go up in the early period was (31.5 ± 7.2) h and (10.3 ± 7.8) h in the two groups respectively, and the time of using the ventilator were (145.0 ± 26.4) h and (98.5 ± 26.7) h respectively Time were (23.7 ± 15.4) d, (14.4 ± 6.0) d respectively. There were significant differences between the two groups (P <0.01). The incidence of PPHN in both groups were 8 and 3 respectively. The pneumothorax was 8 and 4 respectively. VAP was 13 and 9, respectively, with 11 and 7 deaths, respectively. The incidence of HIE were 7 cases, 5 cases; no significant difference; overall mortality rate was 40.9%. Conclusion To relax the indications for upper extremity in children with severe MAS and get the machine on as soon as possible can greatly shorten the use of ventilator and hospitalization time, reduce the incidence of complications and reduce the mortality.