肺复张策略在早产儿呼吸窘迫综合征中的应用  被引量:6

Application of lung recruitment maneuver in preterm infants with respiratory distress syndrome

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作  者:覃晓菲[1] 张晓[1] 游楚明[1] 傅万海[1] 孟琼[1] 谢燕丕[1] 赵有为[1] 

机构地区:[1]广东省第二人民医院儿科,广州510317

出  处:《中国新生儿科杂志》2016年第6期418-421,共4页Chinese Journal of Neonatology

基  金:广东省科技计划项目(2014A020213024)

摘  要:目的探讨肺复张策略在早产儿呼吸窘迫综合征(RDS)中的治疗效果。方法选择我院新生儿重症监护中心住院的符合纳入标准的RDS早产儿,随机分为肺复张组与对照组,其中肺复张组在机械通气同时行肺复张。记录两组新生儿治疗后1、6 h的吸入氧浓度(FiO_2)、呼气末正压(PEEP)、平均气道压(MAP),并计算氧合指数(OI),两组进行比较分析,并对肺复张组复张前后不同时间点FiO_2、PEEP、OI的变化进行比较。结果共纳入RDS早产儿25例,其中肺复张组12例,对照组13例,两组新生儿性别、胎龄、出生体重,以及开始肺复张前FiO_2、PEEP和OI比较差异均无统计学意义(P>0.05)。肺复张组1、6 h的FiO_2均低于对照组[(31±8)%比(49±14)%、(25±5)%比(43±13)%],1、6 h的OI亦低于对照组[(4.3±1.5)比(6.9±4.0)、(3.2±1.4)比(6.0±3.6)],差异均有统计学意义(P<0.05)。肺复张组1、6 h的FiO_2及OI均低于肺复张前(P<0.05),PEEP高于肺复张前(P<0.05),6 h的FiO_2及OI均低于1 h(P<0.05)。与对照组比较,肺复张组并未增加肺表面活性物质使用次数及拔管失败、支气管肺发育不良、医院感染的比例(P>0.05),但可减少总呼吸支持时间及氧疗时间(P<0.05)。结论肺复张策略治疗早产儿RDS能较快改善OI,减少呼吸支持时间及氧疗时间。Objective To investigate the effect of lung recruitment maneuver( RM) in preterm infants with respiratory distress syndrome( RDS). Methods Twenty-five preterm infants who were diagnosed RDS and met the inclusion criteria in the neonatal intensive care unit of our hospital were enrolled and the patients were randomly assigned into RM group and control group. Infants in RM group( n = 12) received RM first then they were supported by conventional mechanical ventilation. Infants in control group( n = 13) were only supported by conventional mechanical ventilation. The fraction of inspired oxygen( FiO_2),positive end-expiratory pressure( PEEP),mean airway pressure( MAP),oxygenation index( OI) in two groups were recorded before therapy and after the first and sixth hour after treatment. The data was then compared between groups. Results Between two groups,there were no significant differences in gender,gestational age,birth weight,FiO_2,PEEP and OI before RM( P〈0. 05). FiO_2 and OI on the 1 h and 6 h after RM were much lower than those in control group respectively [FiO_2:( 31 ± 8) % vs.( 49 ± 14) %,( 25 ± 5) % vs.( 43 ± 13) %,OI:( 4. 3 ± 1. 5) vs.( 6. 9 ± 4. 0),( 3. 2 ± 1. 4) vs.( 6. 0 ± 3. 6) ]( P〈0. 05). In RM group,FiO 2and OI after RM were significantly lower than those before RM( P〈0. 05). PEEP was higher than that before RM( P〈0. 05). FiO 2and OI on the 6 h after RM were much lower than those on the 1 h after RM( P〈0. 05).Compared with control group,duration of the positive-pressure ventilation and oxygen therapy were much shorter in the RM group( P〈0. 05). However,there were no significant differences in the doses of pulmonary surfactant administered,incidence of bronchopulmonary dysplasia,duration of extubation failure and nosocomial infection between two groups( P〉0. 05). Conclusions RM can improve OI more quickly,shorten the duration of positive-pressure ventilation and oxygen therapy in prete

关 键 词:呼吸窘迫综合征 新生儿 婴儿 早产 肺复张 通气 机械 

分 类 号:R722.6[医药卫生—儿科]

 

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