摘要
目的探讨Ⅱ型呼吸衰竭新生儿高频通气时呼吸力学特征及其临床意义。方法选择Ⅱ型呼吸衰竭新生儿31例,随机分为观察组16例,对照组15例。观察组采用高频通气治疗并行呼吸力学指标监测,对照组采用同步间歇指令通气进行治疗。观察在高频通气治疗前及治疗后2、12、24、48h及撤机前患儿呼吸系统动态顺应性(C)、呼吸道阻力(R)、肺过度膨胀系数(C20/C)、每分通气量(MV)、平均呼吸道压(MAP)等指标并进行比较。对二组患儿治愈率及病死率进行比较。结果观察组患儿C随疾病的好转逐渐增加,撤机前与治疗前相比有显著性差异(P<0.01);R在撤机前明显降低,与治疗前相比有显著性差异(P<0.01);MV在撤机前明显升高,与治疗前相比有显著性差异(P<0.01);MAP逐渐下降,C、MV及R均与肺部病变的严重程度有关。与对照组相比,观察组治愈率(87.5%)较对照组(80%)高,病死率(6.25%)较对照组(13.3%)低,但统计学分析均无明显差别(Pa>0.05)。结论Ⅱ型呼吸衰竭新生儿高频通气时呼吸力学动态监测可判断肺部病变的严重程度,评估通气策略,掌握撤机时机。高频通气是治疗Ⅱ型呼吸衰竭新生儿的重要手段之一。
Objective To explore respiration mechanics characteristics and clinical significance in neonates with Ⅱ type respiratory, failure during high - frequency ventilation（HFOV）. Methods Thirty - one neonates with Ⅱ type respiratory, failure were selected, whom were randomly divided observation group（ n = 16 ） and control group（ n = 15 ） ; HFOV were used to observation group and inspected respiratory, mechanics index, synchronized intermittent mandatory, ventilation were used to control group ;The dynamic compliance（C） ,respiratory. resistance（ R）, lung inflation index （C20/C）, minute volumec （MV）, mean air wag pressure （MAP） before HFOV treating and after 2,12,24,48 h treating and before withdra- wing ventilator were compared. At the same time, curing rate and death rate were compared between observation and control groups. Results With disease improving, C increased gradually in observation group,there were significant difference before withdrawing ventilator and before treatment （P 〈0.01 ） ;compared with pre - cure, resistance decreased and MV increased markedly before withdrawing（ P, 〈 0.01 ） ; MAP decreased gradually, C, MV and R were related to lung disease. Curing rate （87.5%） were higher in observation group than that of control group （80%）, whereas mortality ratio were lower in group observation （6.25%） than that of control group （ 13.3% ）. But there were no significant difference （ Pa 〉 0. 05 ）. Conclusions Measuring respiratory, dynamic mechanics in neonatal HFOV to Ⅱ type respiratory, failure can estimate severity degree of lung pathological changes and ventilating strategy,hold opportunity of withdrawing ventilator. HFOV is one of important means to cure Ⅱ type neonatal respiratory failure.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2007年第14期1066-1067,共2页
Journal of Applied Clinical Pediatrics
关键词
Ⅱ型呼吸衰竭
婴儿
新生
高频通气
呼吸力学
Ⅱ type respiratory insufficiency
infant, newborn
high - frequency ventilation
respiratory mechanics
