摘要
目的探讨不同的机械通气策略对抢救新生儿肺透明膜病的临床效果。方法将148例新生儿肺透明膜病患儿分为三组，在相同综合治疗的基础上，A组42例用面罩持续吸氧（氧流量4～6L／min）或无创持续气道正压（CPAP）通气（流量6～8L／min，FiO20．4～0．6，压力为5～8cmH2O）；B组52例，用传统的机械通气（CMV），潮气量（VT）12～15ml／kg，呼吸频率（RR）30～40次／min，气道峰压（PIP）〈3．43kPa，呼气末正压（PEEP）（1．12±0．34）kPa；C组54例，运用肺保护性机械通气（LPSV），潮气量6～8ml／kg，呼气末正压（0．84±0．21）kPa，吸入氧浓度（FiO2）由0．8逐渐降至0．3，吸／呼比（I：E）为1：1．5～2．0。观察三组患儿治疗后的临床症状、血气变化及并发症、病死率。结果A组与B、C组相比，未实施机械通气患者的病死率显著升高（P〈0．05）；传统策略机械通气组病死率及并发症高于运用肺保护性通气策略组（P〈0．05）。结论机械通气可显著降低新生儿肺透明膜病的病死率；肺保护性机械通气策略可进一步减少新生儿肺透明膜病的并发症，降低病死率。
Objective To probe into clinical curative effect of different mechanical ventilation strategies on rescuing hyaline membrane disease of the newborn. Methods 148 neonates with hyaline membrane disease（HMD） who all accepted the same combined therapy were randomly divided into 3 groups： group A including 42 cases treated by continuously inhaling oxygen via nasal/mouth mask（oxygen flow 4-6L/min） or CPAP（oxygen flow 6-8L/min,FiO2 0.4-0.6,pressure 5- 8cmH2O） ;group B including 52 cases treated by conventional mechanical ventilation（CMV） whose parameters were VT 12 - 15ml/kg, RR 30- 40bpm, PIP 〈 3.43kPa, PEEP （ 1.12 ± 0.34） kPa and group C including 54 cases treated by lung protective strategy ventilation（LPSV） whose parameters were VT 6- 8ml/kg, PEEP （0.84 ± 0.21 ）kPa,FiO2 0.8 down to 0.3, I ： E = 1 ： 1.5 - 2.0. Then the clinical symptom, blood gas change, incidence rate of complication and case fatality rate were observed after treatment among 3 groups. Results Compared with group B and group C, the case fatality rate in group with non-CMV rose significantly（ P 〈 0.05 ）;the incidence rate of complication and the case fatality rate in group with CMV were higher than those in group with LPSV（P 〈 0.05 ）. Conclusion Mechanical ventilation could significantly degrade the case fatality rate of neonates with HMD; LPSV strategy could further decrease the complication and the case fatality rate of neonates with HMD.
出处
《中国基层医药》
CAS
2008年第1期47-49,共3页
Chinese Journal of Primary Medicine and Pharmacy
关键词
呼吸
人工
透明膜病
婴儿
新生
Respiration,artificial
Hyaline membrane disease
Infant,newborn
