Wung J T, James L S, Kilchevsky E, James E
Pediatrics. 1985 Oct;76(4):488-94.
The successful management of 15 infants suffering from persistence of fetal pulmonary circulation and in severe respiratory failure is presented. The treatment regimen focused on minimizing barotrauma. Infants were intubated nasotracheally and ventilated with intermittent mandatory ventilation. Peak inspiratory pressures were determined by the clinical assessment of chest excursion. Ventilator settings and fractional inspiratory oxygen (FiO2) were selected to maintain a PaO2 between 50 and 70 mm Hg; PaCO2 was not a controlling parameter and was allowed to increase as high as 60 mm Hg. Hyperventilation and muscle relaxants were not used. High ventilator rate was used in ten infants who required high inspiratory pressure to maintain chest excursion, with a favorable response in five. Tolazoline was given to 14 infants of whom ten showed an improvement in oxygenation; dopamine was given to three infants who were oliguric. All infants survived, and only one infant developed chronic lung disease which was defined by the infant's need for supplemental oxygen beyond 30 days of life.
本文介绍了对15例患有持续性胎儿肺循环且严重呼吸衰竭的婴儿的成功治疗。治疗方案的重点是尽量减少气压伤。婴儿经鼻气管插管，采用间歇强制通气进行通气。吸气峰压通过胸部活动的临床评估来确定。选择呼吸机设置和吸入氧分数（FiO2）以维持动脉血氧分压（PaO2）在50至70毫米汞柱之间；动脉血二氧化碳分压（PaCO2）不是控制参数，允许其升高至60毫米汞柱。未使用过度通气和肌肉松弛剂。10例需要高吸气压力来维持胸部活动的婴儿使用了高呼吸机频率，其中5例有良好反应。14例婴儿使用了妥拉唑啉，其中10例氧合改善；3例少尿婴儿使用了多巴胺。所有婴儿均存活，只有1例婴儿发展为慢性肺病，定义为婴儿在出生30天后仍需要补充氧气。
