目的 探讨小潮气量通气联合允许性高碳酸血症治疗足月儿重症胎粪吸入综合征的临床效果.方法 回顾性分析经常频机械通气 (SIMV通气) 治疗的57例重症胎粪吸入综合征足月儿的临床资料,将患儿分为研究组31例 (应用小潮气量联合允许性高碳酸血症) 和对照组26例 (应用传统大潮气量、维持正常二氧化碳) 进行比较分析.结果 研究组治疗期间动脉血pH值、氧分压 (PaO2) 均低于对照组,二氧化碳分压 (PaCO2) 高于对照组,差异均有统计学意义 (P 均<0.05);研究组呼吸机相关性肺损伤 (VALI) 发生率、病死率、上机时间、吸氧时间、住院时间均低于对照组,差异有统计学意义 (P 均<0.05);两组间肺出血、肺动脉高压等并发症发生率的差异无统计学意义 (P >0.05).结论 重症胎粪吸入综合征新生儿机械通气时实施小潮气量联合允许性高碳酸血症策略,可缩短机械通气时间、吸氧时间和住院时间,显著降低VALI的发生率和病死率,是一种较为安全有效的通气策略.%Objectives To explore the clinical efficacy of low tidal volume and permissive hypereapnia on treatment severe meconium aspiration syndrome (MAS) is term neonatal. Methods The dimesl data of 57 term neonatal with MAS were retrospectively analyzed. They were divided into research group. 31 cases applied with low tidal volume and permissive hypercapnia, and control group, 26 cases applied with high tidal volume and normal carbon dioxide. Resits Daring the treatment, arterial pH, pressure of oxygen (PaO2) in research group were lower, while pressure of carbon dioxide (PaCo2) was higher than those in control group (P＜0.05). Incidence of ventilator-associated long injury (VALI), mortality, ventilation use, duration of oxygen, hospitalization in research group were significantly lower than those in control group (P＜0.05), while no significant differences were found between 2 groups in pulmonary hemorrhage and pulmonary artery hypertension. Conclusions Ventilation using low tidal volume with permissive hypereapnia can significantly reduce the incidence of VALI in term neonatal meconium aspiration syndrome, shorten the duration of oxygen, ventilation use and hospitalization, and therefore is a relatively safe and effective ventilation approach.
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