早产儿呼吸衰竭有创机械通气后不同呼吸机撤离方式的有效性和安全性  

Effectiveness and safety of different ventilator weaning strategies after mechanical ventilation in premature infants with respiratory failure

作　　者：王新媛 宋磊 WANG Xinyuan;SONG Lei(Department of Neonatology,Second Affiliated Hospital,Nantong University,Nantong 226001,CHINA)

机构地区：[1]南通大学第二附属医院(南通市第一人民医院)新生儿科,江苏226001

出　　处：《江苏医药》2021年第12期1253-1257,共5页Jiangsu Medical Journal

基　　金：南通市科技项目(MS12020004)。

摘　　要：目的探讨呼吸衰竭早产儿行辅助控制通气(A/C)后不同呼吸机撤离方式的安全性及有效性。方法98例呼吸衰竭早产儿初始均采取A/C模式有创机械通气,随后符合撤离A/C标准后撤机,观察组50例患儿直接撤机,对照组48例患儿采用同步间歇指令通气模式撤机。所有患儿拔除气管插管后给予经鼻间歇正压通气。记录两组72 h内呼吸机撤离失败率、A/C后呼吸机使用时间、总氧疗时间、住院时间、住院费用、并发症发生情况等。结果与对照组相比,观察组患儿A/C后呼吸机使用时间、总氧疗时间、住院时间稍有减少(P>0.05);观察组住院费用少于对照组(P<0.05)。两组呼吸机撤离失败率以及颅内出血、呼吸机相关性肺炎、支气管肺发育不良、动脉导管未闭发生率比较差异无统计学意义(P>0.05)。结论呼吸衰竭早产儿停A/C后直接撤机,继之采用无创辅助通气,安全、有效,并且可以减少住院花费。Objective To investigate the effectiveness and safety of different ventilator weaning strategies after assist-control ventilation(A/C)in premature infants with respiratory failure.Methods A total of 98 premature infants initially accepted A/C mode of mechanical ventilation after birth.When the standard of weaning A/C was met,A/C was directly weaned and then nasal intermittent positive pressure ventilation was given in 50 cases(group A)or A/C was weaned and synchronous intermittent mandatory ventilation was conducted in 48 cases(group B).The failure rate of ventilator weaning within 72 hours,duration of mechanical ventilation after A/C,total oxygen supply time,hospital stay and medical expense,and the incidence of complications were compared between the two groups.Results Compared with group B,the duration of mechanical ventilation after A/C,total oxygen supply time and hospital stay were slightly decreased in group A(P>0.05).The hospital expense in group A was less than that in group B(P<0.05).There were no statistical differences in the failure rate of ventilator weaning and the incidences of intracranial hemorrhage,ventilator-associated pneumonia,bronchopulmonary dysplasia and patent ductus arteriosus between the two groups(P>0.05).Conclusion Directly using the noninvasive ventilation for A/C weaning is safe and effective with reduced hospital costs in premature infants with respiratory failure.

关 键 词：呼吸衰竭 早产儿 同步间歇指令通气 经鼻间歇正压通气 

分 类 号：R772[医药卫生—眼科]