摘要
目的观察成比例辅助通气(PAV)治疗早产儿呼吸窘迫综合征(ARDS)的疗效。方法使用Stephanie3.3型呼吸机PAV模式,采用自身前后对照,对2007年8月-2009年3月收住本科首先使用持续呼吸道正压通气(CPAP)疗效不佳且符合病例纳入标准的18例ARDS患儿改用PAV治疗,参数:呼气末正压(PEEP)为0.29～0.59kPa;后备通气设计呼吸暂停最长允许时间为10s,呼气压峰值为1.77～2.45kPa,PEEP为0.29～0.59kPa,呼吸频率(RR)为30～50次·min-1,吸气时间(TI)为0.3～0.5s,流量(FR)为8～12L·min-1;弹性阻力卸载值为50～150kPa·L-1,呼吸道黏性阻力卸载值为2.45～7.35kPa·L-1·s-1;呼出潮气量的最低容量为患儿体质量×5mL,呼出最高容量限制为患儿体质量×10mL,PIP限定为2.94kPa,最长吸气时间限定为0.7s。对比其前后1h的平均血压、RR、心率、血气分析,观察治疗效果。结果18例患儿使用PAV前后平均血压变化不明显(t=0.78,P>0.05),RR、心率明显减慢(t=11.80、8.80,Pa<0.05),血气分析中pa(O2)、pa(CO2)、pH值明显改善(t=8.67、6.49、5.46,Pa<0.05),且心率、RR和血气分析渐接近正常或者正常。结论成比例辅助通气可有选择性试用于ARDS的治疗。
Objective To observe the curative effect of proportional assist ventilation（PAV） on preterm infants with respiratory distress syndrome（ARDS）.Methods In a controlled before-after study,18 preterm infants with ARDS who accorded with the inclusive criteria and had been hospitalized in our ward from Aug.2007 to Mar.2009,were treated by PAV of Stephanie 3.3 respirator with uniferm oxygen concentration,while the curative effect of continuous positive airway pressure（CPAP） was bad.Mean blood pressure,respiratory rate（RR）,heart rate,blood gas analysis were tested and contrasted before and after using PAV one hour.The parameters listed below were set while the preterm infant was treated by PAV,peak end-expiratory pressure（PEEP） was around 0.29-0.59 kPa.In case of the longest time of apnea was 10 s under PAV,backup respiration must be carried out,peak inspiratory pressure（PIP） was around 1.77-2.45 kPa,RR was around 30-50 times·min-1,inspiratory time was around 0.3-0.5 s,and flow rate was around 8-12 L·min-1.The degree of the elastic relief was around 50-150 kPa·L-1,the degree of the resistive relief was around 2.45-7.35 kPa·L-1·s-1;The guarantee on lowest exp-tidal volume in milliliter was 5 times the quality of preterm infant whlie the limit on the largest exp-tidal volume was 10 times,the highest PIP was set to 2.94 kPa,the longest inspiratory duration was set to 0.7 s.Results Mean blood pressure of the 18 pretern infants was not significantly diffe-rent before and after using PAV 1 hour（t=0.78,P0.05）.RR,heart rate,pa（O2）,pa（CO2）,hydrogen ion exponent were significantly improved after 1 hour using PAV（t=11.80,8.80,8.67,6.49,5.46,Pa〈0.05）,and they were gradually normal or normal.Conclusion PAV may be attempted to treat preterm infants with RDS selectively.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第2期121-122,共2页
Journal of Applied Clinical Pediatrics
基金
广东省医学科研基金立项课题(A2008730)
江门市科技局立项课题[江科(2008)40]
关键词
成比例辅助通气
呼吸窘迫综合征
婴儿
早产
proportional assist ventilation respiratory distress syndrome preterm infant
