潮气量对极低出生体重儿高频震荡通气时p(CO_(2))的影响及最佳设置分析  

Influence of tidal volume on p(CO_(2)) and the optimal setting during high-frequency oscillation ventilation in very-low-birth-weight infants

作　　者：苌俊明 李德亮[1] 朱萍[1] 程雪莲[1] 赵杰 高航 CHANG Jun-ming;LI De-liang;ZHU Ping;CHENG Xue-lian;ZHAO Jie;GAO Hang(Neonatal Intensive Care Unit,Nanyang Central Hospital,Nanyang,Henan 473000,China)

机构地区：[1]南阳市中心医院新生儿重症监护室,河南南阳473000

出　　处：《中华实用诊断与治疗杂志》2021年第2期143-146,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省2020年科技发展计划项目(202102310079)。

摘　　要：目的观察极低出生体重儿高频震荡通气(high-frequency oscillation ventilation, HFOV)时血p(CO_(2))的变化,探讨潮气量对血p(CO_(2))的影响及最佳潮气量值。方法接受HFOV治疗的极低出生体重儿80例,记录通气过程中各项参数,包括呼吸频率、呼吸幅度、平均气道压、吸入氧浓度、潮气量、每分通气量、p(CO_(2))、二氧化碳扩散系数(carbon dioxide diffusion coefficient, DCO_(2)),共监测毛细血管血气数据812个,其中p(CO_(2))≥55 mm Hg的血气数据439个为观察组,p(CO_(2))<55 mm Hg的血气数据373个为对照组,比较2组呼吸参数;采用多因素logistic回归分析极低出生体重儿p(CO_(2))升高的影响因素;绘制ROC曲线,评估潮气量及其他通气参数对极低出生体重儿p(CO_(2))升高的预测效能。结果观察组吸入氧浓度(0.49±0.13)高于对照组(0.32±0.14)(P<0.05),潮气量[(1.62±0.37)mL/kg]、每分通气量[(0.61±0.29)mL/kg]及DCO_(2)[(32.49±14.92)mL^(2)/s]均低于对照组[(2.18±0.52)mL/kg、(0.92±0.23)mL/kg、(68.47±31.44)mL^(2)/s](P<0.05);潮气量(OR=0.028,95%CI:0.006~0.132,P<0.001)、每分通气量(OR=0.003,95%CI:<0.001~0.028,P<0.001)、DCO_(2)(OR=0.936,95%CI:0.910~0.963,P<0.001)是极低出生体重儿p(CO_(2))升高的影响因素;潮气量、每分通气量、DCO_(2)的最佳截断值分别为1.81 mL/kg、0.62 mL/kg、38.84 mL^(2)/s时,预测极低出生体重儿p(CO_(2))升高的AUC分别为0.833(95%CI:0.766~0.887,P<0.001)、0.596(95%CI:0.516~0.673,P<0.001)、0.830(95%CI:0.762~0.885,P<0.001),灵敏度分别为81.25%、93.75%、72.50%,特异度分别为75.00%、31.25%、93.75%,潮气量及DCO_(2)预测极低出生体重儿p(CO_(2))升高的AUC明显高于每分通气量(P<0.05)。结论潮气量对使用HFOV呼吸支持的极低出生体重儿p(CO_(2))有明显影响,保持潮气量不低于1.81 mL/kg对控制p(CO_(2))水平有较好指导价值。Objective To observe the changes of blood p(CO_(2)) during high-frequency oscillation ventilation(HFOV) in very-low-birth-weight infants, and to investigate the influence of tidal volume on blood p(CO_(2)) and the optimal value setting. Methods Eighty very-low-birth-weight infants receiving HFOV were recorded the ventilation parameters during HFOV including respiratory frequency, respiratory amplitude, mean airway pressure, fractional concentration of inspired oxygen, tidal volume, minute ventilation volume, p(CO_(2)) and carbon dioxide diffusion coefficient(DCO_(2)). Totally 812 capillary blood gas data were obtained, and were divided into 439 data with p(CO_(2)) ≥ 55 mm Hg(observation group) and 373 data with p(CO_(2)) <55 mm Hg(control group). The differences of respiratory parameters were compared between two groups. Multivariate logistic regression was used to analyze the influencing factors of high p(CO_(2)), and ROC was drawn to evaluate the efficiencies of tidal volume and other ventilation parameters on predicting p(CO_(2)) increase.Results The fractional concentration of inspired oxygen was higher in observation group(0.49±0.13)than that in control group(0.32±0.14)(P<0.05),while the tidal volume,minute ventilation volume and DCO_(2) were lower in observation group((1.62±0.37)mL/kg,(0.61±0.29)mL/kg,(32.49±14.92)mL^(2)/s)than those in control group((2.18±0.52)mL/kg,(0.92±0.23)mL/kg,(68.47±31.44)mL^(2)/s)(P<0.05).The tidal volume(OR=0.028,95%CI:0.006-0.132,P<0.001),minute ventilation volume(OR=0.003,95%CI:0.000-0.028,P<0.001)and DCO_(2)(OR=0.936,95%CI:0.910-0.963,P<0.001)were the influencing factors of high p(CO_(2))in very-low-birth-weight infants.When the optimal cut-off values of tidal volume,minute ventilation volume and DCO_(2) were 1.81 mL/kg,0.62 mL/kg and 38.84 mL^(2)/s,the AUCs for predicting p(CO_(2))increase were 0.833(95%CI:0.766-0.887,P<0.001),0.596(95%CI:0.516-0.673,P<0.001)and 0.830(95%CI:0.762-0.885,P<0.001),the sensitivities were 81.25%,93.75% and 72.50%,and the specificities wer

关 键 词：极低出生体重儿 高频振荡通气 p(CO_(2)) 潮气量 每分通气量 二氧化碳扩散系数 

分 类 号：R720.5[医药卫生—儿科]