手控高频持续正压通气转运新生儿重型先天性膈疝的临床研究  

Application of hand control high frequency continuous positive airway pressure on the neonatal transport of severe congenital diaphragmatic hernia

作　　者：李春亮[1] 劳晓玲[1] 

机构地区：[1]中国人民解放军第181医院全军计划生育优生优育技术中心新生儿科,桂林541002

出　　处：《中国小儿急救医学》2015年第1期30-33,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的 探讨运用自动充气式复苏囊（self-inflating bag,SIB）＋ PEEP阀手控高频持续正压通气在重型先天性膈疝（congenital diaphragmatic hernia,CDH）院前急救中的临床应用.方法 回顾分析由我科院前急救小组转运的28例重型CDH患儿的临床资料,根据转运途中使用手控SIB＋ PEEP阀高频持续气道正压通气及手控SIB正压通气两种不同通气方法分为治疗组16例和对照组12例,观察两组患儿病情加重、并发症发生,监测并比较转运治疗前后不同通气时间的血气值.结果 治疗组患儿转运途中病情无加重,无一例气漏、肺出血、持续肺动脉高压、颅内出血;入院后术前多器官功能衰竭死亡2例（12.5％,2/16）,术后死亡5例（31.3％,5/16）.对照组患儿病情加重8例（66.7％,8/12）、气漏5例（41.7％,5/12）、持续肺动脉高压并肺出血3例（25.0％,3/12）、颅内出血1例（8.3％,1/12）;入院后术前多器官功能衰竭死亡5例（41.7％,5/12）,术后死亡4例（33.3％,4/12）.监测治疗组与对照组患儿转运途中治疗前后各时间点的动脉血气pH、PaCO2、PaO2、PaO2/FiO2,差异均有统计学意义（P均＜0.05）.结论 早期给予SIB＋ PEEP阀手控高频持续正压通气,可提高重型CDH患儿转运成功率及存活率,减少并发症的发生.Objective To investigate the clinic application significance of hand control high frequency continuous positive airway pressure treatment with self-inflating bags（SIB） fitted with positive end expiratory pressure （PEEP） valves on the neonatal transport of severe neonatal congenital diaphragmatic hemia （CDH）.Methods Clinical data of a total of 28 infants with severe CDH transported by the pre-hospital emergency care team of our department were analyzed.The 28 patients were divided into treatment group （n =16） and control group （n =12）.Hand control high frequency continuous positive airway pressure of SIB and PEEP valve were administered in the treatment group,while only hand control SIB positive airway pressure were given in the control group during the transportation.The exacerbation,complication and blood gas indicators at different time before and after treatment in two groups were monitored and compared.Results In the treatment group,no case aggravated,no case complicated with gas leakage,pulmonary hemorrhage,persistent pulmonary hypertension,intracranial hemorrhage; 2 cases died for multiple organ failure before operation （12.5％）,5 cases died after operation （31.3％）.In the control group,8 cases aggravated （66.7％）,cases complicated with gas leakage,pulmonary hemorrhage,persistent pulmonary hypertension,intracranial hemorrhage were 5 （41.7 ％）,3 （25.0％）,1 （8.3 ％）,respectively; 4 cases died for multiple organ failure before operation （41.7％）,5 cases died after operation （33.3％）.The indexes of pH,PaO2,PaCO2 and PaO2/FiO2 at different time before and after treatment between the treatment group and the control group or in each separate group all showed statistical significance （P ＜ 0.05）.Conclusion Early accurate diagnosis during transportation with hand control high frequency continuous positive airway pressure of SIB fitted with PEEP valves for CDH is a safe and effective ventilation method which can reduce complications and increase success

关 键 词：手控高频持续正压通气 自动充气式复苏囊 呼气末正压 先天性膈疝 

分 类 号：R726.5[医药卫生—儿科]