不同通气模式下的肺复张策略治疗早产儿呼吸窘迫综合征的临床观察  

Clinical observation of lung recruitment maneuver under different ventilation modes in the treatment of premature infants with neonatal respiratory distress syndrome

作　　者：颜陶[1] 陶志允 廖沛娜 杨敏霞[1] Yan Tao;Tao Zhiyun;Liao Peina;Yang Minxia(Gaoming People's Hospital,Foshan,Guangdong 528500,China)

机构地区：[1]广东省佛山市高明区人民医院,广东佛山528500

出　　处：《首都食品与医药》2022年第18期48-51,共4页Capital Food Medicine

基　　金：佛山市卫生和健康局医学科研课题(项目编号:20202006)。

摘　　要：目的对比分析常频机械通气(CMV)和高频振荡通气(HFOV)模式下使用肺复张(LRM Lung Recruitment Maneuver)策略治疗早产儿呼吸窘迫综合征(NRDS)的临床效果.方法将收治的60例NRDS并需进行有创机械通气治疗的患儿随机分为30例的常频组和30例的高频组,分别给予CMV和HFOV的模式通气治疗,并在相应的机械通气模式下行肺复张(LRM)操作.结果两组患儿治疗前各项指标均无明显差异(P>0.05).两组患儿行肺复张(LRM)治疗后1h、6h的动脉血氧分压(PaO_(2))明显高于治疗前,动脉血二氧化碳分压(PaCO_(2))、吸入氧浓度(FiO_(2))和氧合指数(OI)明显低于治疗前,其中高频组改善程度更为明显.高频组患儿机械通气时间、拔管后无创通气支持时间、撤机后给氧时间、平均总住院时间和常频组对比明显较低,差异有统计学意义(P<0.05).结论NRDS患儿在CMV和HFOV的通气模式下行肺复张(LRM)操作治疗后,临床结果和血气指标均有明显改善,但HFOV通气模式下肺复张(LRM)治疗后的患儿各项监测指标的改善程度更为明显,能减少支气管肺发育不良(BPD)的发生率,是一种安全有效的治疗方法.Objective To compared and analyze the clinical effect of lung recruitment maneuver(LRM)under conventional mechanical ventilation(CMV)and high frequency oscillatory ventilation(HFOV)modes in the treatment of neonatal respiratory distress syndrome(NRDS)in premature infants.Methods Sixty admited children with NRDS who needed invasive mechanical ventilation were randomly divided into conventional frequency group(n=30)and high-frequency group(n=30),CMV and HFOV ventilation modes were given two groups respectively.LRM operations in the corresponding mechanical ventilation mode was conducted.Resul ts There were no significant differences in the indicators of the two groups before treatment(P>0.05).The arterial partial pressure of oxygen(Pa0_(2))at lh and 6h after LRM treatment in the two groups was significantly higher than that before treatment,while the arterial partial pressure of carbon dioxide(PaCO_(2)),inhaled oxygen concentration(FiO_(2)),and blood gas oxygenation index(OI)after treatment were significantly lower than those before treatment,and the improvement was more obvious in thehigh-frequency group.The mechanical ventilation time,non-invasive ventilation support time after extubation,oxygen time after ventilation,and average total length ofhospital stay in thehigh-frequency group were lower than those in the conventional frequency group,and differences were statistically significant(P<0.05).Conclusions Application of LRM under CMV and HFOV modes for the treatment of NRDS can significantly improve the clinical and blood gas indicators,but the improvement of the monitored indicators after LRM treatment under HFOV mode is more obvious,which can reduce the incidence of broncho-pulmonary dysplasia(BPD),and it is a safe and effective treatment method.

关 键 词：CMV HFOV LRM NRDS FIO2 OI 并发症 治愈 

分 类 号：R722.12[医药卫生—儿科]