摘要
目的研究神经调节辅助通气(NAVA)对早产儿呼吸窘迫征(RDS)的临床效果及对血气指标、呼吸力学相关参数的影响。方法收集医院早产儿重症监护病房自2015年3月~2017年4月收治的RDS患儿88例,按随机数字表法分为观察组与对照组各44例。观察组给予NAVA模式行辅助通气,对照组给予同步间歇指令通气(SIMV)模式行辅助通气。治疗后对两组血气指标、呼吸力学相关参数及并发症发生率进行对比评价。结果观察组吸气触发延迟时间明显短于对照组(P<0.05);两组的动脉血pH、SpO_2、PaO_2、PaCO_2以及PaO_2/FiO_2等血气指标改善程度均明显优于治疗前(P<0.05);但两组对比差异无统计学意义(P>0.05);两组的RR、MAP、PIP、EAdi峰值、EAdi谷值、MVi、VTi、WOB等呼吸力学相关参数改善情况均明显优于治疗前(P<0.05);但观察组膈肌电活动信号、RR、PIP以及WOB等指标均明显低于同时期的对照组(P<0.05);两组在并发症发生率上对比差异无统计学意义(P>0.05)。结论在早产儿RDS的治疗中,应用NAVA通气模式可有效缩短触发延迟,能以更低的气道压力实现同样的气体交换,还可减少膈肌负荷,降低气道峰压及呼吸做功且不会增加并发症发生率,安全可靠,可作为临床最优的机械通气模式进行推广。
Objective To study the clinical effect of Neurally Adjusted Ventilatory Assist（NAVA）on respiratory distress syndrome（RDS）in preterm infants,and analyze the effects of neurological regulation on the parameters of blood gas and respiratory mechanics.Methods 88 children with RDS were enrolled in the intensive care unit of our hospital from March 2015 to April 2017.The children were divided into observation group and control group according to the random number table method.The observation group was given NAVA mode line assisted ventilation.The control group was given synchronous intermittent command ventilation（SIMV）mode line assisted ventilation.After treatment,the blood gas,respiratory mechanics parameters and the incidence of complications were observed.Results The inspiratory delay time of the observation group was significantly shorter than that of the control group（P〈0.05）.The levels of arterial blood pH,SpO2,PaO2,PaCO2 and PaO2/FiO2 after treatment were significantly better than those before treatment（P〉0.05）,but there was no significant difference between the two groups（P〈0.05）.The improvement of respiratory mechanics parameters such as RR,MAP,PIP,EAdi peak,EAdi valley,MVi,VTi and WOB after treatment were significantly better than those before treatment（P〈0.05）.The parameters of diaphragmatic electrical activity,RR,PIP and WOB in the observation group were significantly lower than those in the control group（P〈0.05）.There was no significant difference in the incidence of complications between the two groups（P〈0.05）.Conclusion In the treatment of RDS in preterm infants,NAVA ventilation mode can effectively shorten the trigger delay,achieve the same gas exchange with lower airway pressure,and reduce the diaphragm load,reduce airway peak pressure and breathe work and not increase the incidence of complications.
作者
张艳
李书芳
蒋秀芳
雷延龄
ZHANG Yan;LI Shufang;JIANG Xiufang;LEI Yanling(Department of Neonatology,The First Hospital of Handan,Handan 056002,Hebei,China;Department of Pediatrics,The First Affiliated Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Pediatrics,The Second Pediatric Hospital Affiliated to Hebei Medical University,Shijiazhuang 050003,China)
出处
《西部医学》
2018年第9期1361-1364,共4页
Medical Journal of West China
基金
河北省2016年度医学科学研究重点指导性课题计划(20160346)
