摘要
目的比较传统通气策略和肺保护性通气策略(LPSV)应用于新生儿急性呼吸衰竭机械通气的治疗效果和相关并发症的发生情况,评价LPSV的临床应用价值。方法将不同原因引起符合急性呼吸衰竭诊断标准并符合上机指征的新生儿急性呼吸衰竭48例患儿随机分为两组:A组23例,用传统机械通气策略;B组25例,运用LPSV。观察指标包括:吸入氧浓度(FiO2)、吸气峰压(PIP)、呼气终末正压(PEEP)、平均动脉压(MAP)、潮气量(VT),动脉血pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。呼吸机相关性肺损伤(VALI)、脑室内出血(IVH)、动脉导管未闭(PDA)、肺出血的发生率和病死率及呼吸机应用时间、住院时间。结果 B组患儿的PIP、MAP、VT均短于A组,差异均有统计学意义(P<0.001)。B组患儿的动脉血PaCO2高于A组,且B组的动脉血pH低于A组,差异均有统计学意义(P<0.001);两组动脉血PaO2比较差异无统计学意义(P>0.05)。B组的VALI发生率低于A组,差异有统计学意义(P<0.05)。而两组患儿IVH、PDA、肺出血的发生率及病死率比较,差异均无统计学意义(P>0.05)。B组的上机时间及住院时间均短于A组,差异均有统计学意义(P<0.05)。结论采用LPSV治疗新生儿呼吸衰竭可降低呼吸机相关性肺损伤的发生率,缩短了患儿上机时间及住院时间,是一种相对较为安全有效的通气策略。
Objective To evaluate the role of lung protective ventilation strategy in the ventilation therapy for neonatal acute respiratory failure.Methods A total of 48 neonatal patients with acute respiratory failure who met the indication of ventilator use were divided into two groups： group A （n=23）,applied with conventional ventilation strategy;and group B （n=25）,applied with lung protective ventilation strategy.Observation indicators included： fraction of inspired oxygen （FiO2）,peak inspiratory end positive pressure （PIP）,positive end-expiratory pressure （PEEP）,mean airway pressure （MAP）,tidal volume （VT）,arterial pH,arterial partial pressure of oxygen （PaO2）,arterial partial pressure of carbondioxide （PaCO2）,incidence and mortality of ventilator-associated lung injury （VALI）,intraventricular hemorrhage （IVH）,patent ductus arteriosus （PDA）,pulmonary hemorrhage （PH）,and duration of ventilator use and hospitalization.Results PIP,MAP,and VT were significantly lower in group B than in group A （P0.001）,while PaO2 showed no significant difference （P0.05）.The incidence of VALI was significantly higher in group A than in group B （P0.05）,while IVH,PDA,and PH were not significantly different between two groups （P0.05）.The duration of ventilator use and hospitalization were significantly longer in group A than in Group B （P0.05）.Conclusion For neonatal acute respiratory failure,lung protective ventilation strategy can decrease the incidence of VALI and shorten the duration of ventilator use and hospitalization,and therefore is a relatively safe and effective ventilation strategy.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第27期3029-3031,共3页
Chinese General Practice
关键词
婴儿
新生
呼吸功能不全
呼吸机
机械
Infant
newborn
Respiratory insufficiency
Ventilators
mechanical
