新生儿允许性高碳酸血症时脑血流变化研究  

Study on cerebral blood flow change of neonates with permissive hypercapnia

作　　者：丁刚[1] 周翔[1] 陈兰珍[2] 唐沂[2] 刘静华[1] 肖政祥[1] 王强[1] 

机构地区：[1]广东省深圳市龙岗区妇幼保健院新生儿科,518172 [2]广东省深圳市人民医院新生儿科

出　　处：《中国妇幼保健》2014年第12期1854-1857,共4页Maternal and Child Health Care of China

基　　金：广东省深圳市科技(医药卫生)计划项目[201203339]

摘　　要：目的：探讨新生儿允许性高碳酸血症（PHC）时脑血流的变化。方法：观察深圳市龙岗区妇幼保健院及深圳市人民医院需机械通气的60例新生）LD3z吸窘迫综合征（NRDS）住院早产患儿并随机分为两组，每组30例。观察组在呼吸机治疗期间，根据临床反应、血气分析结果、呼吸机参数（以降低潮气量为主）相互关系，最终调节达pH7．30-7．40、PaCO246—60mmHg的PHC；对照组以同样的方式维持pH7．35～7．45、PaCO，35～45mmHg，两组PaO：均维持在50-100mmHg。所有患儿在24～72h内做大脑中动脉血流检测，测量参数包括收缩期峰值血流速度（Vs）、舒张末期血流速度（Vd）、收缩期血流速度与舒张末期血流速度的比值（S／D）、早期阻力指数（RI）及搏动指数（PI）。结果：两组患儿对脑血流有影响的因素比较差异无统计学意义（P〉0．05）。通气策略改变前，两组呼吸机参数比较差异无统计学意义（P〉0．05）；通气策略改变后，观察组患儿平均气道压（MAP）和吸气压峰值（PIP）、吸气时间（rri）下降，两组比较差异有统计学意义（P〈0．05）。两组血气检测结果比较：观察组pH值低于对照组，PaCO2高于对照组，差异有统计学意义（P〈0．05）；而两组PaO2／FiO2、PaO2、心率和血压比较差异无统计学意义（P〉0．05）。两组患儿脑血流Vs、Vd、S／D、RI、PI比较差异无统计学意义（P〉0．05）。结论：只要维持血循环稳定、PaO250～100mmHg，患儿脑血流参数改变不明显，PHC通气策略治疗NRDS是安全、可行的。Objective： To explore the cerebral blood flow change of neonates with permissive hypercapnia （PHC） . Methods： Sixty premature infants with neonatal respiratory distress syndrome （NRDS） needing mechanical ventilation in the hospital and Shenzhen Peo- ple＇s Hospital were observed and randomly divided into two groups, 30 infants in each group. Based on interrelation among clinical reaction, the results of blood gas analysis and respiratory parameters （ giving priority to reduce the tidal volume） in observation group during breath ma- chine treatment, the relevant parameters of HPC were adjusted eventually to make pH reach 7.30 - 7.40 and PaCO2 reach 46 - 60 mmHg, children in control group maintained at pH 7.35 -7.45 and PaCO2 35 -45 mmHg in the same way, PaO2 maintained at 50 - 100 mmHg in the two groups. The middle cerebral artery blood flow of all the children were detected within 24 - 72 hours, the measuring parameters in- cluded peak systolic velocity （Vs）, end diastolic velocity （Vd）, the ratio of peak systolic velocity and end diastolic velocity （S/D） , earlyresistance index （RI） and pulsatility index （PI） . Results： There was no statistically significant difference in the influencing factors of cerebral blood flow between the two groups （P 〉 0. 05 ） . Before yen-tilation strategy changed, there was no statistically significant difference in breathing machine parameters between the two groups （P 〉 0. 05 ） ; after ventilation strategy changed, mean airway pressure （MAP）, peak inspiratory pressure （PIP）, and inspiratory time （Ti） in ob- servation group decreased, compared with control group, there were statistically significant differences （P 〈 0. 05） . pH value in observation group was statistically significantly lower than that in control group （ P 〈 0. 05 ）, while PaCO2 in observation group was statistically signifi- cantly higher than that in control group （ P 〈 0.05 ） ; there was no statistically significant difference in PaOJ

关 键 词：新生儿 允许性高碳酸血症 脑血流 

分 类 号：R722.19[医药卫生—儿科]