动态氧合监测对HFOV治疗新生儿呼吸衰竭的作用  

DYNAMIC OXYGENATED MONITORING ON NEONATES WITH RESPIRATORY FAILURE TREATED WITH HIGN FREQUENCY OSCILLATORY MECHANICAL VENTILATION

作　　者：崔兆芳[1] 崔凤静[1] 杨燕玲[1] 周继勇 单若冰 

机构地区：[1]青岛大学医学院儿科学教研室,山东青岛266021 [2]青岛市妇女儿童医院

出　　处：《青岛大学医学院学报》2013年第4期359-361,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨高频振荡机械通气(HFOV)治疗呼吸衰竭新生儿24h内动态氧合参数变化及其对预后判断价值。方法收集在青岛市妇女儿童医院NICU发生呼吸衰竭并使用HFOV治疗新生儿43例,记录病儿应用HFOV后0、2、6、12、24h的血液pH值、氧分压(PaO2)、二氧化碳分压(PaCO2)及平均气道压(MAP)、吸入氧浓度(FiO2),并计算各时段的肺泡氧分压/动脉氧分压(a/A)比值、氧合指数(OI)、肺泡-动脉氧分压差(A-aDO2)及0、6、12h呼吸窘迫评分。结果生存组HFOV治疗2h后PaO2、PaCO2、OI、A-aDO2、MAP、FiO2与治疗前比较差异有显著性(t=-5.90～6.85,P<0.05);治疗6、12、24h后PaO2、PaCO2、pH、a/A比值、OI、A-aDO2、MAP、FiO2与治疗前相比,差异均有显著性(t=-10.30～9.73,P<0.05)。死亡组以上指标虽也有所改善,但与治疗前相比,差异无显著性(P>0.05)。生存组治疗后6、12h呼吸窘迫评分与治疗前比较,差异有显著性(t=10.82、14.51,P<0.05),死亡组治疗后与治疗前比较差异无显著性(P>0.05)。结论对HFOV治疗的呼吸衰竭新生儿24h内进行动态氧合参数检测可帮助判断其预后。Objective To investigate changes of dynamic oxygenation parameters （DOP） within 24 hours and assess its value in predicting the prognosis in neonates with respiratory failure treated with high frequency oscillatory mechanical ventilation （HFOV）. Methods Data of 43 neonates with respiratory failure treated with HFOV-in NICU of Qingdao Women and Children Hospital were collected. The pH value of blood, partial pressure of oxygen （PaO2） and carbon dioxide （PaCO2）, mean airway pressure （MAP）, and fraction of inspired oxygen （FiOz） at 0,2, 6,12 and 24 hours after using HFOV were respectively recorded, and ratio of alveolar oxygen partial pressure and PaO2 in artery （a/A）, oxygenation index（OI）, alveolar-arterial oxygen partial pressure difference （A-aDO2） at each time were calculated, and respiratory distress at 0, 6 and 12 hours was scored. Results In survival group, after 2 h of HFOV treatment, the differences of PaO2 ,PaCO2,O0I,A aDO2, MAP,and FiO2 were significant as compared with that before treatment （t =-5.90--6.85,P〈0.05）, and PaO2, PaCO2, blood pH, a/A, OI, A-aDO2, MAP, and FiO~ were all improved at 6, 12, and 24 h versus before HFOV （t=-10.30--9.73,P〈0.05）. In the death group, though the above parameters showed somewhat improvements, the differences were not significant as compared with that before treatment （P〈0.05）. As for respiratory distress scores, the differences between before and after therapy in survival group were significant （t=10.82,14.51;P〈0.01）, but not in the death group （P〈0.05）. Conclusion Monitoring the 24-hour DOP in neonates with respiratory failure treated with HFOV may help predict its prognosis.

关 键 词：呼吸功能不全 婴儿 新生 血气监测 经皮 预后 高频通气 

分 类 号：R722.12[医药卫生—儿科]