摘要
为了探讨新生儿肺出血的诊治线索 ,回顾性分析193例患儿临床资料。将患儿分3组 :甲组162例(尸检证实 ,根据口鼻腔无或有流血又分Ⅰ组68例 ,Ⅱ组94例) ,乙组16例应用呼吸机治疗 ,丙组为改进治疗措施后的15例。诊断及结果判断标准根据发病的高危因素、临床特点、插管吸出血性液体及胸片表现。治疗予气管内滴入1:10000肾上腺素或立止血。呼吸机参数平均为I/E1∶1.2 ,FiO2 0.8±0.2 ,PIP23.5±5.2cmH2O ,PEEP4.1±0.6cmH2O,RR55.2±10.5次/分 ,流量8L/分。结果青紫、体温不升、惊厥、神志不清Ⅰ组高于Ⅱ组 ,而黄疸、心律失常、肺部罗音Ⅱ组高于Ⅰ组。乙丙2组的治愈、病死率各为43.8 %、100 %及56.2%、0%(P均<0.01) ;合并症各为8、3例。提示加强肺、心、肾、脑、循环功能的监测与防治 。
The aim of this retrospective study is to explore the experience about the diagnosis and treatment as well as the possible improvement of the cure rate for the cases of neonatal pulmonary haemorrhage.Based on the criteria of early diagnosis of this disease,namely high_risk factors,clinical manifestations,the laboratory determination of bloody secretions aspirated via intubation,radiological features and so forth,193 cases of neonatal pulmonary haemorrhage encountered in the hospital in past 38 years were enrolled in this study and thereby divided into 3 groups as follows:162 autopsies from August,1962 to June,1998 as group A,16 cases mainly treated by routine mechanical ventilation from 1985 to 1995 as group B and 15 mcases treated by improved mechanical ventilation from 1996 to 2000 as gruop C.In groups B and C,there was little difference in clinical data,such as sex, gestational age,birth weight,onset age and abnormal labor(all P>0.05).Concerning the therapeutical measures used in the cases of groups B and C, the intra_tracheal administration of 1∶10000 epinephrine or/and botropase solution was first adopted in drop form through tracheal intubation almost before the mechanical ventilation was decided to be undertaken(the average parameters applied:I/E,1∶1.2;FiO2 ,0.8±0.2;PIP, 23.5±5.22cmH2O;PEEP,4.1±0.6cmH2O;RR, 55.2±10.5times/min;flow volume,8L/min, etc).From the results obtained,as compared between 68 non_bleeding cases(class 1)and 94 massive bleeding cases(class 2)in the total of group A, the appearance rate of some clinical manifestations, such as cyanosis,hypothermia,convulsion,and lethargy,in class 1 was significantly higher than in class 2,whileas this rate of other clinical manifestations,i.e. jaundice,arrhythmias and rales in lungs in class 2 was significantly higher than that in class 1(P<0.01 and P<0.05,respectively).Meanwhile,it was also revealed that the cure rate of groups B and C was separately 43.8% and 100%(P<0.01),and ,in other word,the mortality of group B was 56.2%. In addition, the
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2003年第2期94-96,共3页
Journal of Clinical Pediatrics
关键词
新生儿
肺出血
诊断
治疗
pulmonary haemorrhage neonate diagnosis treatment
