中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2009年
2期
128-130
,共3页
压力支持通气%纤维支气管镜检查%婴儿,新生%血气分析
壓力支持通氣%纖維支氣管鏡檢查%嬰兒,新生%血氣分析
압력지지통기%섬유지기관경검사%영인,신생%혈기분석
Pressure support ventilation%Fiberoptic bronchoscopy%Infant,newborn%Blood gas analysis
目的 探讨新生儿纤维支气管镜(纤支镜)检查的通气管理.方法 对23例纤支镜检查新生儿进行前瞻性研究,分为两组(A组12例,B组11例),均通过Y型装置与纤支镜吸引孔连接进行压力支持通气(PSV).A组于纤支镜进至气管隆突后给予PSV,B组于整个检查过程都给予PSV.检查过程持续经皮血氧饱和度(SpO2)监测及心电监护,分别在检查前、纤支镜通过声门前、纤支镜退出气管前、检查结束后20～30 min 4个时段抽取动脉血进行血气分析.以检查前SpO2、PaCO2、PaO2值作为基线,其余3个时段值与基线进行比较.结果 23 例新生儿均完成纤支镜检查.纤支镜通过声门前,SpO2、PaCO2、PaO2与基线相比差异无显著性.当通过声门后,A组11例(92%)出现发绀,SpO2明显降低(P＜0.01),降幅达25%;当纤支镜达到气管隆突,应用PSV后,发绀消失,SpO2恢复至基线值,PaO2在纤支镜退出气管前维持在基线水平.B组全部病例的SpO2、PaO2在整个检查过程中均维持在基线水平.纤支镜通过声门后,两组PaCO2均明显升高(P＜0.01),但检查结束后20～30 min内,均可恢复到基线水平.结论 纤支镜检查可引起新生儿明显低氧血症及高碳酸血症,通过纤支镜PSV是维持纤支镜检查新生儿正常氧合的有效、安全的通气技术.
目的 探討新生兒纖維支氣管鏡(纖支鏡)檢查的通氣管理.方法 對23例纖支鏡檢查新生兒進行前瞻性研究,分為兩組(A組12例,B組11例),均通過Y型裝置與纖支鏡吸引孔連接進行壓力支持通氣(PSV).A組于纖支鏡進至氣管隆突後給予PSV,B組于整箇檢查過程都給予PSV.檢查過程持續經皮血氧飽和度(SpO2)鑑測及心電鑑護,分彆在檢查前、纖支鏡通過聲門前、纖支鏡退齣氣管前、檢查結束後20～30 min 4箇時段抽取動脈血進行血氣分析.以檢查前SpO2、PaCO2、PaO2值作為基線,其餘3箇時段值與基線進行比較.結果 23 例新生兒均完成纖支鏡檢查.纖支鏡通過聲門前,SpO2、PaCO2、PaO2與基線相比差異無顯著性.噹通過聲門後,A組11例(92%)齣現髮紺,SpO2明顯降低(P＜0.01),降幅達25%;噹纖支鏡達到氣管隆突,應用PSV後,髮紺消失,SpO2恢複至基線值,PaO2在纖支鏡退齣氣管前維持在基線水平.B組全部病例的SpO2、PaO2在整箇檢查過程中均維持在基線水平.纖支鏡通過聲門後,兩組PaCO2均明顯升高(P＜0.01),但檢查結束後20～30 min內,均可恢複到基線水平.結論 纖支鏡檢查可引起新生兒明顯低氧血癥及高碳痠血癥,通過纖支鏡PSV是維持纖支鏡檢查新生兒正常氧閤的有效、安全的通氣技術.
목적 탐토신생인섬유지기관경(섬지경)검사적통기관리.방법 대23례섬지경검사신생인진행전첨성연구,분위량조(A조12례,B조11례),균통과Y형장치여섬지경흡인공련접진행압력지지통기(PSV).A조우섬지경진지기관륭돌후급여PSV,B조우정개검사과정도급여PSV.검사과정지속경피혈양포화도(SpO2)감측급심전감호,분별재검사전、섬지경통과성문전、섬지경퇴출기관전、검사결속후20～30 min 4개시단추취동맥혈진행혈기분석.이검사전SpO2、PaCO2、PaO2치작위기선,기여3개시단치여기선진행비교.결과 23 례신생인균완성섬지경검사.섬지경통과성문전,SpO2、PaCO2、PaO2여기선상비차이무현저성.당통과성문후,A조11례(92%)출현발감,SpO2명현강저(P＜0.01),강폭체25%;당섬지경체도기관륭돌,응용PSV후,발감소실,SpO2회복지기선치,PaO2재섬지경퇴출기관전유지재기선수평.B조전부병례적SpO2、PaO2재정개검사과정중균유지재기선수평.섬지경통과성문후,량조PaCO2균명현승고(P＜0.01),단검사결속후20～30 min내,균가회복도기선수평.결론 섬지경검사가인기신생인명현저양혈증급고탄산혈증,통과섬지경PSV시유지섬지경검사신생인정상양합적유효、안전적통기기술.
Objective To assess ventilation administration during fiberoptic bronchoscopy (FB) in neonates. Methods Twenty-three neonates divided into two group (A group 12 neonates, B group 11 neonates) received FB. All were given pressure support ventilation (PSV)by a Y-like facility which connected to fiberoptic bronchoscope suction hole. In A group,after the tip of fiberoptic bronchoscope arrived at the carina, PSV was administrated. In B group, PSV was administrated in the entire process during FB, SpO2 and electrocardio were monitoring. Artery blood samples for blood gas analysis were obtained at four stages of just before FB,with the tip of the bronchoscope at the supralarynx,just before withdrawing bronchoscope out off trachea and within 20-30 minutes after FB. The arterial blood oxygen tension (PaO2), arterial blood carbon dioxide tension (PaCO2) and SpO2 just before FB served as baseline. The same indexes of other three stages were compared with the baseline. Results All 23 neonates were studied completely. When the tip of fiberoptic bronchoscope advanced from nostril to the supralarynx, SpO2, PaO2 and PaCO2 in two groups were similar to the baseline. In A group, when the tip below the glottis, cyanosis occurred, and SpO2 decreased significantly ( P＜0. 01 ) in 11 cases (92%) by 25% ; When tip at the carina, after PSV, cyanosis disappeared, and SpO2 returned to the baseline level, PaO2 keep on the baseline just before withdrawing the bronchoscope out of the trachea. SpO2 ,PaO2 in all B group neonates keep on the baseline during FB. After the tip below the glottis,PaCO2 in all neonates of the two groups increased significantly ( P＜0. 01 ), but returned to baseline within 20-30 minutes after FB. Conclusion FB can cause significant hypoxemia and hypercapnia in neonates. PSV through fiberoptic bronchoscope can be considered a safe and beneficial ventilation technique for maintaining oxygenation during FB.
