中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2014年
19期
39-43
,共5页
压力调节容量控制%同步间歇指令通气%肺损伤%新生儿呼吸窘迫综合征
壓力調節容量控製%同步間歇指令通氣%肺損傷%新生兒呼吸窘迫綜閤徵
압력조절용량공제%동보간헐지령통기%폐손상%신생인호흡군박종합정
Pressure regulated volume control ventilation%Synchronized intermittent mandatory ventilation%Barotrau-mas%Neonatal respiratory distress syndrome
目的：观察压力调节容量控制通气(PRVC)和同步间歇指令通气(SIMV)通气在治疗呼吸窘迫综合征(RDS)新生儿时相关参数的变化。方法2013年6月~2014年3月在淮安市妇幼保健院新生儿医学中心出生的,患有呼吸窘迫综合征且需要机械通气58例新生儿,分为PRVC组(32例,采用PRVC通气)和SIMV组(26例,采用SIMV通气)。观察两组机械通气时间、氧疗时间、住院时间、动脉氧分压/肺泡氧分压；观察两组机械通气时酸血症、碱血症、低碳酸血症和高碳酸血症的发生率；观察两组机械通气前、机械通气1、12、24、48、72 h的心率(HR)、呼吸频率(RR)、平均动脉血压(MABP)、气道峰压(PIP)、氧合指数(OI)等变化。结果淤58例RDS新生儿均治愈出院。两组机械通气时间、氧疗时间、住院时间、气胸发生率、颅内出血发生率、支气管发育不良发生率和呼吸机相关性肺炎发生率比较,差异均无统计学意义(P跃0.05)。于两组的HR和RR变化均呈下降趋势,在机械通气72 h时接近正常范围。两组平均动脉血压变化均在正常范围。盂两组PIP变化均呈下降趋势。PRVC组内各个时间点之间PIP比较、SIMV组内各个时间点之间PIP比较,差异均有统计学意义(P<0.05)；PRVC组PIP在机械通气1、12、24、48、72 h均低于SIMV组,差异有统计学意义(P<0.05)。榆两组OI变化均呈下降趋势。PRVC组内各个时间点OI值比较、SIMV组内各个时间点之间OI值比较,差异有统计学意义(P<0.05)。 PRVC组在机械通气1、12、24、48 h的OI值与SIMV组比较,差异均无统计学意义(P跃0.05)。 PRVC组OI在机械通气72 h时低于SIMV组,差异有统计学意义(P<0.05)。虞机械通气时pH值<7.35发生率(PRVC组为16.5%、SIMV组为13.5%)和pH值跃7.45发生率(PRVC组为7.8%、SIMV组为5.2%)比较,差异无统计学意义(P跃0.05)。PRVC组动脉二氧化碳分压(PaCO2)<35 mm Hg的发生率低于SIMV组,差异均有统计学意义(P<0.05)；两组机械通气时PaCO2跃60 mm Hg发生率比较,差异无统计学意义(P跃0.05)。结论RDS新生儿的呼吸支持中,在获得相同的疗效情况下,与SIMV模式比较,PRVC模式下PIP和过度通气的发生率显著降低；PRVC模式可能具有一定的临床应用价值,值得推广。
目的：觀察壓力調節容量控製通氣(PRVC)和同步間歇指令通氣(SIMV)通氣在治療呼吸窘迫綜閤徵(RDS)新生兒時相關參數的變化。方法2013年6月~2014年3月在淮安市婦幼保健院新生兒醫學中心齣生的,患有呼吸窘迫綜閤徵且需要機械通氣58例新生兒,分為PRVC組(32例,採用PRVC通氣)和SIMV組(26例,採用SIMV通氣)。觀察兩組機械通氣時間、氧療時間、住院時間、動脈氧分壓/肺泡氧分壓；觀察兩組機械通氣時痠血癥、堿血癥、低碳痠血癥和高碳痠血癥的髮生率；觀察兩組機械通氣前、機械通氣1、12、24、48、72 h的心率(HR)、呼吸頻率(RR)、平均動脈血壓(MABP)、氣道峰壓(PIP)、氧閤指數(OI)等變化。結果淤58例RDS新生兒均治愈齣院。兩組機械通氣時間、氧療時間、住院時間、氣胸髮生率、顱內齣血髮生率、支氣管髮育不良髮生率和呼吸機相關性肺炎髮生率比較,差異均無統計學意義(P躍0.05)。于兩組的HR和RR變化均呈下降趨勢,在機械通氣72 h時接近正常範圍。兩組平均動脈血壓變化均在正常範圍。盂兩組PIP變化均呈下降趨勢。PRVC組內各箇時間點之間PIP比較、SIMV組內各箇時間點之間PIP比較,差異均有統計學意義(P<0.05)；PRVC組PIP在機械通氣1、12、24、48、72 h均低于SIMV組,差異有統計學意義(P<0.05)。榆兩組OI變化均呈下降趨勢。PRVC組內各箇時間點OI值比較、SIMV組內各箇時間點之間OI值比較,差異有統計學意義(P<0.05)。 PRVC組在機械通氣1、12、24、48 h的OI值與SIMV組比較,差異均無統計學意義(P躍0.05)。 PRVC組OI在機械通氣72 h時低于SIMV組,差異有統計學意義(P<0.05)。虞機械通氣時pH值<7.35髮生率(PRVC組為16.5%、SIMV組為13.5%)和pH值躍7.45髮生率(PRVC組為7.8%、SIMV組為5.2%)比較,差異無統計學意義(P躍0.05)。PRVC組動脈二氧化碳分壓(PaCO2)<35 mm Hg的髮生率低于SIMV組,差異均有統計學意義(P<0.05)；兩組機械通氣時PaCO2躍60 mm Hg髮生率比較,差異無統計學意義(P躍0.05)。結論RDS新生兒的呼吸支持中,在穫得相同的療效情況下,與SIMV模式比較,PRVC模式下PIP和過度通氣的髮生率顯著降低；PRVC模式可能具有一定的臨床應用價值,值得推廣。
목적：관찰압력조절용량공제통기(PRVC)화동보간헐지령통기(SIMV)통기재치료호흡군박종합정(RDS)신생인시상관삼수적변화。방법2013년6월~2014년3월재회안시부유보건원신생인의학중심출생적,환유호흡군박종합정차수요궤계통기58례신생인,분위PRVC조(32례,채용PRVC통기)화SIMV조(26례,채용SIMV통기)。관찰량조궤계통기시간、양료시간、주원시간、동맥양분압/폐포양분압；관찰량조궤계통기시산혈증、감혈증、저탄산혈증화고탄산혈증적발생솔；관찰량조궤계통기전、궤계통기1、12、24、48、72 h적심솔(HR)、호흡빈솔(RR)、평균동맥혈압(MABP)、기도봉압(PIP)、양합지수(OI)등변화。결과어58례RDS신생인균치유출원。량조궤계통기시간、양료시간、주원시간、기흉발생솔、로내출혈발생솔、지기관발육불량발생솔화호흡궤상관성폐염발생솔비교,차이균무통계학의의(P약0.05)。우량조적HR화RR변화균정하강추세,재궤계통기72 h시접근정상범위。량조평균동맥혈압변화균재정상범위。우량조PIP변화균정하강추세。PRVC조내각개시간점지간PIP비교、SIMV조내각개시간점지간PIP비교,차이균유통계학의의(P<0.05)；PRVC조PIP재궤계통기1、12、24、48、72 h균저우SIMV조,차이유통계학의의(P<0.05)。유량조OI변화균정하강추세。PRVC조내각개시간점OI치비교、SIMV조내각개시간점지간OI치비교,차이유통계학의의(P<0.05)。 PRVC조재궤계통기1、12、24、48 h적OI치여SIMV조비교,차이균무통계학의의(P약0.05)。 PRVC조OI재궤계통기72 h시저우SIMV조,차이유통계학의의(P<0.05)。우궤계통기시pH치<7.35발생솔(PRVC조위16.5%、SIMV조위13.5%)화pH치약7.45발생솔(PRVC조위7.8%、SIMV조위5.2%)비교,차이무통계학의의(P약0.05)。PRVC조동맥이양화탄분압(PaCO2)<35 mm Hg적발생솔저우SIMV조,차이균유통계학의의(P<0.05)；량조궤계통기시PaCO2약60 mm Hg발생솔비교,차이무통계학의의(P약0.05)。결론RDS신생인적호흡지지중,재획득상동적료효정황하,여SIMV모식비교,PRVC모식하PIP화과도통기적발생솔현저강저；PRVC모식가능구유일정적림상응용개치,치득추엄。
Objective To observe the changes of related parameter of neonates with respiratory distress syndrome (RDS) ventilated by pressure regulated volume control ventilation (PRVC) and synchronized intermittent mandatory ventilation (SIMV). Methods From June 2013 to March 2014, in Maternity and Child Health Care Hospital of Huai'an City, 58 cases of neonates with respiratory distress syndrome (RDS) who required mechanical ventilationwere were divided into PRVC group (32 cases, ventilated by PRVC) and SIMV group (26 cases, ventilated by SIMV), and the values of related clinical and respirator parameters were recorded and analyzed. The mechanical ventilation time, oxygen cure time, hos-pital stay and arterial oxygen partial pressure/alveolar oxygen partial pressure. The incidence of acidemia, al-kalemia and low carbonate and hypercapnia in two groups were observed. The changes of heart rate (HR), respiratory rate (RR), mean arterial blood pressure (MABP), peak inspiratory pressure (PIP) and oxygenation index (OI) when at mechanical ventilation for 1, 12, 24, 48 and 72 hours in two groups were observed. Results [1]All 58 cases of neonates with respiratory distress syndrome (RDS) were recovered, there were no statistically significant differences be-tween the two groups in the time of mechanical ventilation, oxygen therapy time, the hospitalization time, the incidence of intracranial bleeding, the incidence of bronchial dysplasia and the incidence of ventilator-associated pneumonia(P>0.05).[2]The changes of HR and RR showed downtrend, and were in the normal range at mechanical ventilation for 72 hours in two groups. The changes of MABP in the two groups were in normal range. [3]The changes of PIP showed downtrend in two groups. PIP at the different time in the different group were compared, the differences were statisti-cally significant (P<0.05). PIP in PRVC group were lower than those in SIMV group at mechanical ventilation for 1, 12, 24, 48 and 72 hours, the differences were statistically significant (P< 0.05). [4]The changes of OI showed down-trend. OI at the different time in the different group were compared, the differences were statistically significant (P<0.05). in PRVC group were compared with those in SIMV group at mechanical ventilation for 1, 12, 24, 48 hours, the differences were not statistically significant (P> 0.05). OI in PRVC group was lower than that in SIMV group at me-chanical ventilation for 72 hours, the difference was statistically significant (P<0.05).There was no statistically sig-nificant difference between two groups in the incidence of pH<7.35 (PRVC group was 16.5%, SIMVwas 13.5%) and pH>7.45 (PRVC group was 7.8%, SIMV was 5.2%) when at the mechanical ventilation (P> 0.05). The incidence of PaCO2<35 mm Hg in PRVC group was lower than that in SIMV group at mechanical ventilation, the difference was sta-tistically significant (P<0.05). There was no statistically significant difference between two groups in the incidence of PaCO2>60 mm Hg when at mechanical ventilation (P>0.05). Conclusion In the case to achieve the same of effect, the PIP and the incidence of hyperventilation in PRVC mode are significantly lower than that of in SIMV mode. So the PRVC mode may has some certain value in clinical application and worth of promotion.
