手控高频持续正压通气在转运新生儿重型肺出血中的应用  

Application of hand control high frequency continuous positive airway pressure on the neonatal transport of severe pulmonary hemorrhage

作　　者：李春亮[1] 劳晓玲[1] 

机构地区：[1]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,广西桂林541002

出　　处：《临床急诊杂志》2015年第1期35-38,共4页Journal of Clinical Emergency

摘　　要：目的:探讨用自动充气式复苏囊(SIB)提供呼气末持续正压(PEEP)设备,手控高频持续正压通气在转运新生儿重型肺出血的临床方法和应用价值。方法:需转运新生儿重型肺出血36例,在气管插管解除气道梗阻、止血、纠酸、抗休克等对症支持治疗基础上,采用SIB+PEEP阀手控高频持续正压通气,观察患儿病情加重、并发症发生,监测并比较治疗前及治疗后不同通气时间的血气值。结果:100%转运成功,转运途中病情无恶化,无1例气漏、持续肺动脉高压,治疗前与治疗后各时间点血气PH、PaO2、PaCO2、PaO2/FiO2分别进行配对t检验,P<0.01,表明治疗后肺的通气、换气有明显改善;治愈30例(83.33%),合并多器官功能衰竭放弃后死亡6例(16.67%)。结论:手控高频持续正压通气转运新生儿重型肺出血方法可靠、有效、便于推广。Objective：To investigate the clinic application significance of hand control high frequency continu- ous positive airway pressure （CPAP） treatment with self-inflating bags （SIB） fitted with positive end expiratory pressure （PEEP） valves on the neonatal transport of severe pulmonary hemorrhage. Method：Clinical data of a total of 36 infants with severe pulmonary hemorrhage transported by our pre-hospital emergency care team are analyzed. In addition to several basic symptomatic treatments of removing obstruction of the airway,hemostasis, correction of metabolic acidosis,hand control high frequency continuous positive airway pressure device of the SIB fitted with PEEP valves is employed. The oxygenation,exacerbation, complication and prognosis of critical cases are observed. The blood gas indicators before and after treatment at different time are compared. Result： The transport success rate is 100% and no 1 case aggravated or complicated with gas leakage or persistent pulmonary hypertension;The indicators of PH,PaO2 ,PaCO2 and PaO2/FiO2 before treatment with CPAP and after showed statistical difference （P〈0.01） ,the pulmonary ventilation is significantly improved. 30 cases recovered （83.33） ,1 case gave up treat- ment because of multiple organ failure （16.67）. Conclusion ： In time treatment during transportation with hand con- trol high frequency continuous positive airway pressure of SIB fitted with PEEP valves for severe pulmonary hem- orrhage is a safety and effective ventilation method which can increase successful transfer and survival rate.

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 新生儿转运 重型肺出血 

分 类 号：R56[医药卫生—呼吸系统]