CAJ | 학술논문

目的探讨调节呼气末正压的肺复张方法在比例辅助通气治疗呼吸窘迫综合征(RDS)早产儿中的效果.方法选择2012年1月至2013年6月在淮安市妇幼保健院住院的30例患有RDS且接受比例辅助通气的早产儿,采用随机数字表随机分为肺复张组和对照组(未采用肺复张)各15例.肺复张组女7例,出生胎龄(29.3±1.2)周,出生体重(1 319±97)g,开始机械通气时Silverman Anderson评分7.3±1.2,肺复张开始时吸入氧浓度(FiO2)0.54 ±0.12;对照组分别为6例,(29.5±1.1)周,(1 295±85)g,6.9±1.4,0.50±0.10.两组基线资料差异无统计学意义(P均＞0.05).肺复张的方法为每5分钟增加呼气末压力(PEEP)0.2 cmH2O(1 cmH2O=0.098 kPa),直至FiO2降低为0.25.然后PEEP开始逐步下调,根据压力-容量曲线设置确定PEEP水平和肺容量.当脉搏氧饱和度(SpO2)下降和FiO2升高时,再次增加PEEP水平直至SpO2稳定.观察2组间相关临床指标的变化.组间比较采用方差分析或t检验.结果肺复张组在使用肺表面活性物质次数、最低FiO2、达到最低FiO2的时间和氧气依赖天数均低于对照组[(1.1±0.3)比(1.5±0.5)次、0.29±0.05比0.39 ±0.06,(103 ±18)比(368±138) min,(7.6±1.0)比(8.8±1.3)d,P=0.027、0.000、0.000、0.021].肺复张过程中肺复张组的最大PEEP高于对照组[(8.4±0.8)比(6.8±0.8)cmH2O,P=0.000].动脉/肺泡氧分压(a/AO2)率逐渐升高(F=37.654,P=0.000).吸入氧浓度逐渐降低(F=35.681,P=0.000).两组均无不良事件发生.结论肺复张能减少RDS早产儿的肺表面活性物质使用次数、呼吸支持和氧气治疗时间.
목적 탐토조절호기말정압적폐복장방법재비례보조통기치료호흡군박종합정(RDS)조산인중적효과.방법 선택2012년1월지2013년6월재회안시부유보건원주원적30례환유RDS차접수비례보조통기적조산인,채용수궤수자표수궤분위폐복장조화대조조(미채용폐복장)각15례.폐복장조녀7례,출생태령(29.3±1.2)주,출생체중(1 319±97)g,개시궤계통기시Silverman Anderson평분7.3±1.2,폐복장개시시흡입양농도(FiO2)0.54 ±0.12;대조조분별위6례,(29.5±1.1)주,(1 295±85)g,6.9±1.4,0.50±0.10.량조기선자료차이무통계학의의(P균＞0.05).폐복장적방법위매5분종증가호기말압력(PEEP)0.2 cmH2O(1 cmH2O=0.098 kPa),직지FiO2강저위0.25.연후PEEP개시축보하조,근거압력-용량곡선설치학정PEEP수평화폐용량.당맥박양포화도(SpO2)하강화FiO2승고시,재차증가PEEP수평직지SpO2은정.관찰2조간상관림상지표적변화.조간비교채용방차분석혹t검험.결과 폐복장조재사용폐표면활성물질차수、최저FiO2、체도최저FiO2적시간화양기의뢰천수균저우대조조[(1.1±0.3)비(1.5±0.5)차、0.29±0.05비0.39 ±0.06,(103 ±18)비(368±138) min,(7.6±1.0)비(8.8±1.3)d,P=0.027、0.000、0.000、0.021].폐복장과정중폐복장조적최대PEEP고우대조조[(8.4±0.8)비(6.8±0.8)cmH2O,P=0.000].동맥/폐포양분압(a/AO2)솔축점승고(F=37.654,P=0.000).흡입양농도축점강저(F=35.681,P=0.000).량조균무불량사건발생.결론 폐복장능감소RDS조산인적폐표면활성물질사용차수、호흡지지화양기치료시간.
Objective To understand the effect of lung recruitment maneuver (LRM) with positive end-expiratory pressure (PEEP) on oxygenation and outcomes in preterm infants with respiratory distress syndrome (RDS) ventilated by proportional assist ventilation (PAV).Method From January 2012 to June 2013,thirty neonates with a diagnosis of RDS who required mechanical ventilation were divided randomly into LRM group(n =15,received an LRM and surport by PAV) and control group(n =15,only surport by PAV).There were no statistically significant differences in female (7 vs.6) ; gestational age [(29.3 ± 1.2)vs.(29.5±1.1) weeks]; body weight[(1 319±97) vs.(1 295±85) g]; Silverman Anderson(SA) score for babies at start of ventilation (7.3 ± 1.2 vs.6.9 ± 1.4) ; initial FiO2 (0.54 ± 0.12 vs.0.50 ±0.10) between the two groups (all P ＞ 0.05).LRM entailed increments of 0.2 cmH2 O(1 cmH2O =0.098 kPa) PEEP every 5 minutes,until fraction of inspired oxygen (FiO2) =0.25.Then PEEP was reduced and the lung volume was set on the deflation limb of the pressure/volume curve.When saturation of peripheral oxygen fell and FiO2 rose,we reincremented PEEP until SpO2 became stable.The related clinical indicators of the two group were observed.Result The doses of surfactant administered (1.1 ± 0.3 vs.1.5 ± 0.5,P =0.027),Lowest FiO2 (0.29 ± 0.05 vs.0.39 ± 0.06,P =0.000),time to lowest FiO2 [(103 ± 18) vs.(368±138) min,P=0.000] and O2 dependency [(7.6±1.0) vs.(8.8±1.3) days,P=0.021] in LRM group were lower than that in control group (all P ＜ 0.05).The maximum PEEP during the first 12 hours of life [(8.4 ± 0.8) vs.(6.8 ± 0.8) cmH2 O,P =0.000] in LRM group were higher than that in control group (P ＜ 0.05).FiO2 levels progressively decreased (F =35.681,P =0.000) and a/AO2 Gradually increased (F =37.654,P =0.000).No adverse events and no significant differences in the outcomes were observed.Conclusion LRM can reduce the doses of pulmonary surfactant administered,time of the respiratory support and the oxygen therapy in preterm children with RDS.