关键词: 早产儿, 极重度支气管肺发育不良, 气管切开/家庭机械通气

Abstract: Background: There has been no report on tracheotomy and home mechanical ventilation therapy for infants with severe bronchopulmonary dysplasia(BPD) in China. Objective: To describe the experience of two cases of severe BPD treated with tracheotomy and home mechanical ventilation therapeutic. Design: Case report. Methods: Clinical characteristics,multidisciplinary evaluation before tracheotomy,and transitional and postdischarge care of two infants with very severe BPD and home mechanical ventilation were reported. Results: Two premature infants were admitted for prolonged dependency of invasive mechanical ventilation (case 1: gestational age of 27+5weeks,7 months and 19 days after birth; case 2:gestational age of 24+6weeks,6 months and 24 days after birth).Evaluations on airway,lung parenchyma,and pulmonary vascular disease were performed,showing severe tracheobronchomalacia and severe heterogeneous lung parenchymal lesions.After multidisciplinary consultation and discussion,tracheotomy and long-term home mechanical ventilation support was indicated as the most suitable management strategy.The indication and risk of tracheotomy and long-term mechanical ventilation were discussed thoroughly with the parents.Tracheotomy was then performed.Both infants were discharged on home ventilators after careful assessment of coordination of postdsicharge care,readiness for home care,training of caregivers,and necessary equipment. Conclusion: Tracheotomy and long-term home mechanical ventilation treatment provided a possible treatment choice for ventilator-dependent severe BPD infants in China,but such treatment required significant efforts from the multidisciplinary medical team and family, and difficulties still remained such as cost, high risk,and postdischarge care.

Key words: Premature infants, Extremely severe bronchopulmonary dysplasia, Tracheotomy/home mechanical ventilation