神经调节辅助通气治疗新生儿急性呼吸窘迫综合征的临床研究  

Clinical study of neuromodulation assisted ventilation in the treatment of neonatal acute respiratory distress syndrome

作　　者：李琳[1] 陈丽萍[1] 周敏丽 晁小云 徐惠芳[1] 王巧芳[1] 蒋文星[1] 刘红霞[1] LI Lin;CHEN Liping;ZHOU Minli;CHAO Xiaoyun;XU Huifang;WANG Qiaofang;JIANG Wenxing;LIU Hongxia(Department of Neonatology,Jiangxi Provincial Children's Hospital,Jiangxi Province,Nanchang330038,China)

机构地区：[1]江西省儿童医院新生儿科,江西南昌330038

出　　处：《中国当代医药》2024年第26期60-63,67,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(20201101)。

摘　　要：目的探讨新生儿急性呼吸窘迫综合征(NARDS)实施神经调节辅助通气(NAVA)治疗的临床价值。方法选取2019年10月至2023年10月的江西省儿童医院的60例NARDS患儿作为研究对象,根据随机数字表法将其分为对照组和观察组每组各30例。对照组患儿采用同步间歇指令通气(SIMV)模式,观察组患儿采用NAVA模式,各通气2 h。比较两组患儿的血气指标、呼吸力学参数、吸气触发延迟时间、并发症率。结果治疗后,两组的动脉氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、氧合指数(PaO_(2)/FiO_(2))比较,差异无统计学意义(P>0.05);治疗后,观察组吸气峰压(PIP)、自主呼吸频率(RR)、呼吸做功(WOB)低于对照组,差异有统计学意义(P<0.05),两组治疗后平均气道压(MAP)、吸气潮气量(VTi)、吸气分钟通气量(MVi)比较,差异无统计学意义(P>0.05);观察组的吸气触发延迟时间短于对照组,差异有统计学意义(P<0.05);两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论对于新生儿NARDS实施NAVA治疗,能实现显著的疾病治疗效果,与SIMV模式比较,可提高人机协调性,降低呼吸做功,且降低气道峰压水平,较为安全可靠。Objective To investigate the clinical value of neurally adjusted ventilatory assist(NAVA)in the treatment of neonatal acute respiratory distress syndrome(NARDS).Methods A total of 60 children with NARDS in Jiangxi Provincial Children's Hospital from October 2019 to October 2023 were selected as the research objects.According to the random number table method,they were divided into the control group and the observation group(30 cases in each group).The control group was ventilated with synchro-nized intermittent mandatory ventilation(SIMV)mode,and the observation group was ventilated with NAVA mode,each grope ventilated for 2 h.Blood gas indexes,respiratory mechanics parameters,inspiratory trigger delay time and complication rate were compared between the two groups.Results After treatment,there were no significant differences in arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation of blood(SaO_(2))and oxygenation index(PaO_(2)/FiO_(2))between the two groups(P>0.05).After treatment,the peak inspiratory pressure(PIP),spontaneous respiratory rate(RR)and work of breath(WOB)in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).The mean airway pressure(MAP),tidal volume(VTi)and minute ventilation volume(MVi)after treatment were no statistically significant between the two groups(P>0.05).The inspiratory trigger delay time in the observation group was shorter than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion NAVA treatment for neonatal NARDS can achieve significant disease treatment effect.Compared with SIMV mode,NAVA can improve man-machine coordination,reduce respiratory work,and reduce airway peak pressure level,which is relatively safe and reliable.

关 键 词：急性呼吸窘迫综合征 神经调节辅助通通气 同步间歇指令通气 人机协调性 

分 类 号：R272.1[医药卫生—中医儿科学]