肺保护性通气策略在新生儿机械通气中的应用  

Lung Protective Ventilation Strategies in Treatment of Neonatal Respiratory Failure

作　　者：杨斌[1] 陈志卿[1] 郑歆婷[1] 

机构地区：[1]福建省妇幼保健院新生儿科,福州350001

出　　处：《福建医科大学学报》2009年第5期393-396,共4页Journal of Fujian Medical University

摘　　要：目的应用肺保护性通气策略和呼吸力学监护指导新生儿呼吸衰竭的机械通气,以降低呼吸机相关性肺损伤。方法收集新生儿呼吸衰竭需机械通气者共58例,分为对照组(传统机械通气组)和观察组(保护性通气策略组),对两组呼吸机参数设置、血气分析、肺功能监测、并发症及疗效等进行对照分析。结果观察组呼吸机参数吸气峰压、平均气道压、吸气时间显著低于对照组(P<0.01);血气分析动脉血二氧化碳分压(PaCO2)高于对照组(P<0.01);pH值逐渐上升,24h开始高于对照组(P<0.05),48h明显(P<0.01);吸入氧浓度24h后低于对照组(P<0.01);而呼吸机相关性肺损伤(VILI)的发生率(P<0.05)、呼吸机应用天数低于对照组(P<0.01),疗效高于对照组(P<0.05)。两组住院时间和脑室内出血(IVH)/脑室周围白质软化(PVL)发生率的比较,差别无统计学意义(P>0.05)。结论应用肺保护性通气策略和呼吸力学监护指导新生儿呼吸衰竭的机械通气,降低VILI的发生率;减少呼吸机应用天数;不影响氧合,PaCO2轻度增高,肾脏代偿良好,不增加IVH/PVL的发生率。Objective To observe the effect of mechanical ventilation with lung protective ventilation strategies and respiratory mechanics adopted for monitoring in the treatment of neonatal respiratory failure, aiming to decrease the incidence of ventilator-associated lung injury（VALI）. Methods 56 cases infants with respiratory failure, who were admitted to neonatal intensive care unit （NICU） from June 2007-Octorber 2008 and treated with mechanical ventilation （SIMV mode）, were randomly divided into conventional mechanical ventilation （CMV） group and lung protective ventilation （LPV） group. Data relevant to the neonates were collected and analyzed, including the ventilator＇s parameter, blood gas, pul- monary function test, complications and therapeutic effectiveness. Results Peak inspiratory presure （PIP）, mean airway presure（MAP）, inspriratory time（Ti） respectively in the LPV group were significantly lower than those in the CMV group（P〈0.01）. The results in arterial blood gas study show that only PaCO2 of the LPV group was higher than that in the CMV group（P〈0.01）, which lasted for 24--48 h after ventilation. The incidence of VALI（P〈0.05）and mechanical ventilation time（P〈0.01）were significantly lower than those in the CMV group while the therapeutic effectiveness of the LPV group was better than that of the CMV group（P〈0.05）. There were no differences in FiO2, PaO2 and pH of arterial blood gas, HR, BP at any time of ventilation（P〉0.05）. There were also no differences in the length of hospitalization, incidence of intraventricular hemorrhage and periventricular leukomalacia （IVH） （P〉0.05）. Conclusions LPV can markedly decrease the incidence of VALI and mechanical ventilation time, without affecting oxygenation. It can also lead to slight increase of PaCOz, good recovering of kidneys, and no changes in the incidence of IVH and PVL.

关 键 词：呼吸 人工 通气机 机械 肺疾病 呼吸窘迫综合征 新生儿 治疗结果 

分 类 号：R722.1[医药卫生—儿科]