The nitrous oxides sucks the treatment and treats neonate's acute _'s prevention and health care of nursing which breathes the depleted companion lung artery high pressure

The nitrous oxides sucks the treatment and treats neonate's acute _'s prevention and health care of nursing which breathes the depleted companion lung artery high pressure
Born acute while breathing depletedly how many days neonate caused the back for various reasons, oxygen deficiency, acidosis can often cause the small blood vessel of lung to shrink, the artery pressure of lung increases, when the artery pressure of lung is close to or exceed the pressure of systemic circulation,through artery conduit and (or) Oval the intersection of hole and level take place distributary of right left, show as serious cyanosis and hypoxemia at being clinical, traditional oxygen treat, correct acidosis, medicine expand lung blood vessel, artificial respiration machine application therapeutic effect good, the case fatality rate is relatively high. NO is that a kind of alternative lung blood vessel expands pharmaceuticals, has not influenced blood pressure of the systemic circulation. Our department adopted NO to suck the acute infant who breathes the depleted companion lung artery high pressure of treatment treatment since 1996, have achieved better result.
A clinical materials
This group infant 17 cases,man 12 cases, 5 a woman, 10 cases among them for or issues of newborn babies early breathe by syndrome (RDS)s poverty-stricken ,5 the intersection of fetus and excrement suck syndrome is 2 case severe to suffocate, carry on taking place poverty-stricken syndrome (ARDS) of breath . 10 RDS babies' average birth weight is 1615 570g, fetus is age 33 3 weeks, other 7 babies' average weight is 3179 535g, fetus is age 41 2 weeks, are admitted to hospital 1- 10h after age makes a living. Through the two-dimentional supersound pursuing and colored Doppler's inspection aroused in interest before NO sucks, is it oval to have hole to make a definite diagnosis of on artery to lung high pressure and (or) Right of the artery conduit level is shunted left, and get rid of the deformity of inborn cardiovascular vessel.
2 methods and results
Because dyspnea and oxygen deficiency carry on the trachea intubate immediately after 17 infants are admitted to hospital, keep in touch with machinery by Bird VIP artificial respiration machine, adopt the pressure to limit the way, all is ill to suck oxygen density (FiO2) Increase to 0.9- 1.0 gradually, the peak of inhaling is pressed exhaled the end is being pressed (PIP/PEEP) In 2.16- 3.53/0.29- 0.59kPa (22- 36/3- 6cmH2O) Between, keep in touch with the number of times 30- 100 times divide, because the condition has not been seen and improved or blood and oxygen saturation lever has been unstable, vim and vigour analysis show the intersection of hypoxemia and disease still, offer NO suck, treat, this group until NO suck at the beginning within machinery keep in touch with 24h case. NO and NO2 sensor did the zero point and standard source of the gas (NO is 84.7ppm, NO2 is 10.4ppm) before sucking Finalize the bid, then link the intersection of output end and close the intersection of infant and (after wet taking device) of breathing etc. to sensor of analysis instrument Monitor continuously, NO source of the gas united in (before wet melting device) the breathing machine exports the cycle with the low flow after depression ,It is 20ppm to begin to suck the density, dropped to 4- 6ppm after 4h, 24h removes NO from side to side. NO 5min about suck, visible blood and oxygen saturation lever raise obviously, 30min can reduce every parameters, for instance of breathing etc. slowly while being about: FiO2, PIP/PEEP, respiratory rate. In the 17 infant, 1 case severe to suffocate, carry on, send ARDS to be invalid, 2 early the intersection of newborn baby and RDS suck behind the NO the serious bleeding phenomenon appearsing, stop NO and die after sucking. Other 14 are after NO suck 1h, the condition takes a favorable turn and continuously steady, FiO2 drops from original 0.9- 1.0 to about 0.6, 24h, behind the inactive NO, can keep normal blood and oxygen saturation lever, it is repeated for condition to have, continue artificial respiration machine withdraw from the breathing machine after the 2- 9 days such as treatment.
3 is attended to and realized
3.1 NO and NO2 guard the disinfecting of the appearance
Monitoring instrument, sensor after using and connecting the circuit, can only clean with the soft cloth of alcohol on Jiao, can't use water washing or adopt the high-pressure steam and gas to sterilize the law to sterilize, can't sterilize with any strong disinfectant either.
3.2 Guarantee the sucking continuously of NO
NO should monitor the density continuously while using, and set up high limit and alarm value of the minimum. Because is half-life is short when NO sucks, only several seconds, so should guarantee to suck continuously while using, use in early days, the intersection of NO and density and relatively high terms of breathing etc., should try hard to prevent the infant from breaking away from the breathing machine for longer time, being expert at the trachea should try hard to shorten time even while attracting, try hard to spend the breathing machine to keep in touch with directly while inhaling the phlegm twice, do not use and recover the human body.
3.3 The condition is observed and guarded
The infant tells the doctor to reexamine the supersound, determines the lung arterial pressure and speed of average blood flow of the lung artery after sucking NO 30min, monitor the artery vim and vigour. Should carry on heart rate, rhythm of the heart, breathes, the dynamic monitoring of arterial pressure, blood and oxygen saturation lever tightly at time when NO sucks, there are two examples that rely on the heart outside the chest to press the infant who maintains the heartbeat in this group of cases, after employing NO to suck, the heart function obviously takes a favorable turn, the self-disciplining recovery of heart. After NO suck, should monitor and record NO, the intersection of NO2 and density, heart rate, breathe, blood pressure, blood and oxygen saturation lever, various the intersection of parameter and once of breathing etc. through 30min while being every. Very every h determines and records once after the condition is steady. According to the analysis of blood and oxygen saturation lever, vim and vigour and breathing machine parameter of adjustment of contacting doctor in time of patient's situation. To early newborn baby, especially extremely low birth weight, the partial pressure of oxygen of too high blood will cause the damages of eyes and lung, so the early newborn baby should maintain blood and oxygen saturation lever at 85%- 95%.
3.4 Observation of toxicity and side effect
3.4.1 Pay attention to the inclination of bleeding. Because NO can influence cGMP level in the blood platelet, inhibits the blood platelet agglutinately, should keep a close eye on the inclination of bleeding while employing NO, in order to take the corresponding measure, it is used that the patient inclined to already bleeding should be careful, use in the course the persons who appears serious bleeding phenomenon are inactive in time. Present 10 of various bleeding phenomena in the patients of this group, among them bleed with the early newborn baby and is inclined to for being serious, this may relate to improving in the early newborn baby's one's own blood coagulation mechanism, have in 10 early newborn babies the bleeding phenomenon at various degrees take place in 7 examples, only 3 of the courageous and upright secretion of respiratory tract appear, ventricles of the brain internal haemorrhage is one, 3 phenomena of serious bleeding, it show as anaemia looks, before fonticuli cranii plump, skin silt spot, last liquid,etc. more secretion, intestines and stomaches coffee-likes courageous and upright in trachea, one obviously oozes the blood with umbilicus department even among them. Have 3 examples the slight bleeding phenomenon take place in being 7 case getting mature, one only has coffee-like gastric juice of small quantity, 1 appear coffee-like gastric juice and the intersection of blood drawing and the intersection of position and skin lay hematoma, and one appears courageous and upright secretion of respiratory tract. There is no obvious regularity to bleed for time to happen, appear after but or stop sucking in several hours after NO sucking. According to the bleeding of different nature, we often adopt the following to attend to the measure: The patient with intracranial hemorrhage, it should be brisk that several is attended to and operated, try hard to reduce and irritate the patient, reduce in the trachea sucking the intersection of phlegm and number of times and shortening, sucking the intersection of phlegm and time, prevent all from lead to the fact and pigeonhole the factor of increasing in the cranium. Persons who bleed of respiratory tract, keep the respiratory tract unobstructed, preventing the blood from being agglutinate stops up the trachea intubate, while sucking the phlegm to finish each time, by instilling in several tracheas of 0.01% of the Epinephrine
|