【摘要】 目的探讨肺保护性通气策略在新生儿呼吸窘迫综合征(NRDS)机械通气治疗中对肺氧合功能的影响及其临床应用评价。方法将需进行机械通气治疗的40例NRDS患儿随机分成两组,即保护通气组(PV组)和传统通气组(CV组),每组20例。对两组呼吸机参数、血气分析结果、肺氧合功能指标、并发症及其他临床资料进行比较分析。结果(1)PV组呼吸机参数吸气峰压、平均气道压和氧浓度显著低于CV组(P均<0.05);呼气末正压高于CV组(P<0.01);两组通气频率(RR)差异无显著性(P>0.05)。(2)PV组PaCO2高于CV组(P<0.01);pH低于CV组(P<0.01);两组PaO2差异无显著性(P>0.05)。(3)PV组上机后48h与72h氧合指数明显低于CV组(P<0.01),动脉血氧分压与肺泡氧分压的比率在机械通气后72h也高于CV组(P<0.01),PaO2/FiO2在各监测时间段差异无显著性(P>0.05)。(4)PV组呼吸机相关性肺损伤的发病率低于CV组(P<0.05)。(5)两组脑室内出血及动脉导管开放的发病率差异无显著性(P>0.05);PV组上机时间均短于CV组(P<0.01),两组病死率比较差异亦无显著性(P>0.05)。结论实施肺保护性通气策略可改善肺部气体氧合,维持适当血氧分压,减少并发症,缩短上机时间,降低病死率,提高患儿的生存质量,不增加脑室内出血、动脉导管开放的发病率。更多还原

【Abstract】 Objective To explore the effects of lung protective ventilation strategies on oxygenation in the treatment of neonatal respiratory distress syndrome and to evaluate clinical value.Methods Forty newborn infants,diagnosed as neonatal respiratory distress syndrome and in need of ventilation support,were divided into protective ventilation(PV) group and conventional ventilation(CV) group randomly.The ventilator settings,arterial blood gas analysis,oxygenation index factors,complications and other clinical data were analyzed and compared between the two groups.Results(1) In the PV group,ventilator settings such as PIP,MAP and FiO2 were significantly less than that in CV group(P<0.05).PEEP was higher than that of CV group(P<0.01).No difference was noted in respiratory rate between the two groups.(2) Compared with CV group,PaCO2 was increased significantly in PV groups(P<0.01) and pH was decreased(P<0.01).PaO2 showed no significant difference between the two groups.(3) OI in PV group was significantly less than that in CV group at 48 h and 72 h after mechanical ventilation(P<0.01).At 72 h after mechanical ventilation,a/APO2 in PV group was significantly higher than that in CV group(P<0.01).There was no significant difference in PaO2/FiO2(P>0.05).(4) Incidence of ventilator-associated lung injury in PV group was significantly decreased than that in CV group(P<0.05).(5) No differences were noted in the incidences of IVH and PDA.The duration of mechanical ventilation in PV group was significantly shorter than that in CV group(P<0.01).There was no significant difference of mortality between the two groups.Conclusion Protective ventilation strategies in the treatment of neonatal RDS can improve lung oxygenation,keep appropriate PaO2,reduce the ventilator-associated lung injury,shorten the duration of mechanical ventilation,decrease mortality,improve the patient’s living quality,but do not increase the incidence of IVH and PDA.更多还原