2种机械通气模式在极低出生体重早产儿呼吸窘迫综合征中的呼吸支持作用  

The role of 2 modes of mechanical ventilation for respiratory support in very low birth weight preterm infants with respiratory distress syndrome

作　　者：李磊[1] 白辉科 许婉婷 蒋依伶 吴晨 刘丽[1] 李德渊 Li Lei;Bai Huike;Jiang Yiling;Wu Chen;Xu Wanting;Liu Li;Li Deyuan(Department of Pediatrics,Chengdu Second People′s Hospital,Chengdu 610021,Sichuan Province,China;Department of Pediatrics,West China Second University Hospital,Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]成都市第二人民医院儿科,610021 [2]四川大学华西第二医院儿科,成都610041

出　　处：《中华妇幼临床医学杂志（电子版）》2022年第2期198-204,共7页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：四川省科技厅重点研发项目(2017SZ0055)。

摘　　要：目的探讨高频振荡通气(HFOV)及同步间隙指令通气+压力支持通气(SIMV+PSV)2种机械通气模式,对呼吸窘迫综合征(RDS)极低出生体重早产儿呼吸支持作用及安全性。方法选择2017年10月至2019年10月,在四川大学华西第二医院进行气管插管-使用肺表面活性物质(PS)-拔管(InSurE)治疗失败的50例RDS极低出生体重早产儿为研究对象。采用回顾性分析法,按照机械通气治疗方法,将其分别纳入观察组(n=25,采用HFOV通气模式治疗)和对照组(n=25,采用SIMV+PSV通气模式治疗)。对2组受试儿的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)、机械通气治疗时间、不同分级RDS受试儿机械通气治疗时间、住院时间进行统计学分析。对2组受试儿颅内出血、支气管肺发育不良(BPD)、早产儿视网膜病变(ROP)、肺炎、新生儿坏死性小肠结肠炎(NEC)等RDS并发症发生率进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,所有受试儿监护人签署参加本研究知情同意书。结果①2组受试儿性别构成比、胎龄、出生体重、生后时间、分娩方式构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。②机械通气治疗24 h后,观察组受试儿PaO_(2)、PaCO_(2)水平及OI明显高于、低于及低于对照组,分别为(90.2±13.8)mmHg(1 mmHg=0.133 kPa)与(82.6±11.5)mmHg,(38.1±5.2)mmHg与(46.5±6.1)mmHg及10.6±2.7与17.3±3.9,并且差异均有统计学意义(t=2.115、P=0.040,t=5.240、P<0.001,t=7.484、P<0.001)。③观察组受试儿机械通气治疗时间、住院时间均短于对照组[(82.6±7.3)h vs(93.7±8.9)h,(27.5±2.5)h vs(31.5±3.0)h],并且差异有统计学意义(t=4.822、5.121,P<0.05)。④观察组Ⅱ、Ⅲ、Ⅳ级RDS受试儿的机械通气治疗时间,均短于对照组,并且差异亦均有统计学意义(P<0.05)。⑤观察组受试儿机械通气治疗相关并发症发生率为4.0%(1/Objective To explore the efficacy and safety of high frequency oscillatory ventilation(HFOV)and synchronized intermittent mandatory ventilation and pressure support(SIMV+PSV)in very low birth weight infants with respiratory distress syndrome(RDS).Methods Fifty very low birth weight preterm infants with RDS who failed after intubation-surfactant-extubation(InSurE)treatment at Chengdu Second People′s Hospital from October 2017 to October 2019 were enrolled.The random number table method was used to divide them into observation group(n=25,treated by HFOV ventilation mode)and control group(n=25,treated by SIMV+PSV ventilation mode).A retrospective analysis was used to statistically analyze the following indexes between two groups:arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI),duration of invasive ventilator support.In addition,the incidence of RDS complications such as intracranial hemorrhage,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),pneumonia and neonatal necrotizing enterocolitis(NEC)were statistically compared between 2 groups.Informed consent was obtained from guardians of each participant.The procedure followed in this study was in accordance with the World Medical Association Declaration of Helsinki revised in 2013.Results①There were no significant differences between two groups in general clinical data,such as gender ratio,gestational age,birth weight,age and delivery mode(P>0.05).②After 24 h of mechanical ventilation support,the PaCO_(2) levels in observation group were significantly higher than those in control group[(90.2±13.8)mmHg vs(82.6±11.5)mmHg](1 mmHg=0.133 kPa),PaCO_(2) levels[(38.1±5.2)mmHg vs(46.5±6.1)mmHg],OI levels(10.6±2.7 vs 17.3±3.9)were significantly lower than those in control group,and the above differences were statistically significant(PaO_(2):t=2.115,P=0.040;PaCO_(2):t=5.240,P<0.001;OI:t=7.484,P<0.001).③The duration of invasive ventilator support and hospital stay were shorter in

关 键 词：高频通气 间歇正压通气 呼吸窘迫综合征 新生儿 血气分析 婴儿 极低出生体重 极低出生体重儿 早产 婴儿 早产 

分 类 号：R72[医药卫生—儿科]