容量目标压力控制＋同步间歇指令通气治疗新生儿呼吸窘迫综合征的疗效  

Efficacy of volume target pressure control and synchronized intermittent mandatory ventilation in treating neonatal respiratory distress syndrome

作　　者：刘郴州[1] 关浩锋[1] 左雪梅[1] 许小慧[1] 郭青云[1] 

机构地区：[1]江门市中心医院/中山大学附属江门医院儿科重症监护病区,529030

出　　处：《中华实用儿科临床杂志》2016年第6期433-436,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：广东省科技计划项目（20138022000030）

摘　　要：目的观察容量目标压力控制（VTPC）＋同步间歇指令通气（SIMV）治疗重症新生儿呼吸窘迫综合征（NRDS）的疗效。方法将2012年10月至2015年3月江门市中心医院NICU收治的56例NRDS患儿随机分为2组：VTPC组和压力控制通气（PCV）组，每组28例。VTPC组采用VTPC-I-SIMV模式，PCV组采用PCV＋SIMV模式，2组性别、出生胎龄、出生体质量比较差异均无统计学意义（P均〉0．05）。试验开始后6h、12h、24h、48h检查动脉血气分析，观察2组有创机械通气时间、氧疗时间、试验开始后4次血气分析中低碳酸血症发生率、病死率和气胸、呼吸机相关性肺炎（VAP）、Ⅲ-Ⅳ级脑室周围-脑室内出血（PvH．IVH）、脑室周围白质软化（PVL）、支气管肺发育不良（BPD）的发生情况。结果试验过程中2组均无退出病例。2组首次使用肺表面活性物质治疗时间、使用肺表面活性物质总剂量比较差异均无统计学意义（P均〉0．05）。VTPC组有创机械通气时间[（71．75±9．82）h]较PCV组[（97．89±16．88）h]短，差异有统计学意义（t=7．083．P=0．000），试验开始后4次血气分析中低碳酸血症发生率VTPC组[（19．64±14．20）％]较PCV组[（47．32±18．43）％]低，差异有统计学意义（t=6．294，P=0．000），VTPC组VAP、PVL的发生率均低于PCV组，差异有统计学意义（χ2=5．197、4．766，P=0．023、0．029），而2组吸氧时间、气胸、Ⅲ-Ⅳ级PVH—IVH、BPD发生率、病死率比较差异均无统计学意义（P均〉0．05）。结论VTPC＋SIMV治疗NRDS的疗效优于PCV＋SIMV。Objective To investigate the efficacy of volume target pressure control（VTPC） and synchronized intermittent mandatory ventilation （SIMV）in treating severe neonatal respiratory distress syndrome （NRDS）. Methods Fifty - six admitted cases with severe NRDS hospitalized in Jiangmen Central Hospital from October 2012 to March 2015 were randomly divided into 2 groups ：28 cases in VTPC group were treated by VTPC and SIMV, and 28 cases in pressure control ventilation （PCV） group were treated by PCV and SIMV. There was no significant difference between 2 groups in terms of gender, gestational age, and birth weight （ all P 〉 0.05 ）. Artery blood gas analysis was performed at 6 hours, 12 hours, 24 hours, and 48 hours respectively after ventilation. The following parameters were observed ： the time of invasive mechanical ventilation, duration of oxygen therapy, mortality and the incidence rates of hypocapnia, pneumo- thorax,ventilator associated pneumonia （ VAP）, grade Ⅲ - Ⅳ periventricular intraventricular hemorrhage （ PVH - IVH） ,periventricular leukomalacia （PVL）and bronchopulmonary dysplasia （BPD）. Results No case in 2 groups withdrew from the test. There was no significant difference between 2 groups in terms of the first treatment time and total doses of poractant alia injection （ all P 〉 0.05 ）. The time of invasive mechanical ventilation in VTPC group [ （ 71.75 ± 9.82 ） h ] was shorter than that in PVC group [ （97.89 ± 16.88 ） h ] （ t = 7. 083, P = 0. 000）. Hypocapnia incidence of four blood gas analysis in VTPC group[ （ 19.64 ± 14.20） % ] was lower than that in PCV group[ （47.32± 18.43 ） % ] （t =6. 294,P =0. 000）. Incidence rates of VAP and PVL in VTPC group were lower than those in PCV group （χ2 = 5. 197 ,P = 0. 023 ;X2 = 4. 766, P = 0. 029 ）. However, duration of oxygen therapy, mortality and the incidence rates of pneumothorax, Ⅲ- Ⅳ PVH - IVH and BPD were not significantly different between 2 groups （ all P 〉 0.05 ）. C

关 键 词：机械通气 呼吸窘迫综合征 治疗 婴儿 早产 

分 类 号：R722.1[医药卫生—儿科]