中国医药导报
中國醫藥導報
중국의약도보
CHINA MEDICAL HERALD
2015年
24期
111-115
,共5页
压力调节容量控制%容量控制%肺损伤%新生儿呼吸窘迫综合征
壓力調節容量控製%容量控製%肺損傷%新生兒呼吸窘迫綜閤徵
압력조절용량공제%용량공제%폐손상%신생인호흡군박종합정
Pressure regulated volume control ventilation%Volume control ventilation%Barotrauma%Neonatal respira-tory distress syndrome
目的：观察压力调节容量控制(PRVC)和容量控制(VC)两种通气模式在治疗新生儿呼吸窘迫综合征(NRDS)时的相关参数变化,评估PRVC在NRDS治疗中的优势。方法选择2014年5月~2015年3月扬州大学医学院附属淮安市妇幼保健院新生儿医学中心住院32例新生儿呼吸窘迫综合征患儿为研究对象,根据呼吸机模式选择不同分为PRVC组(PRVC模式通气,n=17)和VC组(VC模式通气48 h后改PRVC模式通气,n=15),其他的呼吸机参数设置相同。观察两组患儿的出生体重、胎龄、机械通气时间、吸氧时间及平均住院时间；观察机械通气前、机械通气6、24、48 h患儿的呼吸频率、心率及平均动脉压血压,机械通气1、6、2、48 h的气道峰压和氧合指数的变化,以及机械通气时PH值<7.35、pH值>7.45、低碳酸血症(PCO2<35 mmHg)和高碳酸血症(PCO2跃60 mmHg)的发生率。结果32例患儿均痊愈出院。两组患儿出生体重、胎龄、机械通气时间、吸氧时间及平均住院时间比较,差异均无统计学意义(P>0.05)。两组患儿的心率整体呈下降趋势,并且在机械通气48 h时接近正常范围(120~140次/min),各个时间点整体比较差异有高度统计学意义(F=4.381,P<0.01)；呼吸次数整体呈下降趋势,并且在机械通气48 h点接近正常范围(35~60次/min),各个时间点整体比较差异有高度统计学意义(F=10.390,P<0.01)；平均动脉血压各个时间点整体比较差异无统计学意义(P>0.05)。 PRVC组气道峰压在机械通气1、6、24 h时均低于VC组,差异均有统计学意义(P<0.05)；氧合指数数值整体呈下降趋势,机械通气1 h时,PRVC组与VC组比较,差异无统计学意义(P>0.05),机械通气6、24、48 h时差异均有统计学意义(P<0.05)；机械通气时两组pH值>7.45和pH值<7.35的发生率比较,差异均无统计学意义(P>0.05)；机械通气时两组PCO2>60 mmHg和PCO2<35 mmHg的发生率比较,差异无统计学意义(P>0.05)。结论与VC模式比较,PRVC模式治疗NRDS时具有较低的气道峰压,可能降低肺气压伤的发生,是一种肺保护性通气模式。
目的：觀察壓力調節容量控製(PRVC)和容量控製(VC)兩種通氣模式在治療新生兒呼吸窘迫綜閤徵(NRDS)時的相關參數變化,評估PRVC在NRDS治療中的優勢。方法選擇2014年5月~2015年3月颺州大學醫學院附屬淮安市婦幼保健院新生兒醫學中心住院32例新生兒呼吸窘迫綜閤徵患兒為研究對象,根據呼吸機模式選擇不同分為PRVC組(PRVC模式通氣,n=17)和VC組(VC模式通氣48 h後改PRVC模式通氣,n=15),其他的呼吸機參數設置相同。觀察兩組患兒的齣生體重、胎齡、機械通氣時間、吸氧時間及平均住院時間；觀察機械通氣前、機械通氣6、24、48 h患兒的呼吸頻率、心率及平均動脈壓血壓,機械通氣1、6、2、48 h的氣道峰壓和氧閤指數的變化,以及機械通氣時PH值<7.35、pH值>7.45、低碳痠血癥(PCO2<35 mmHg)和高碳痠血癥(PCO2躍60 mmHg)的髮生率。結果32例患兒均痊愈齣院。兩組患兒齣生體重、胎齡、機械通氣時間、吸氧時間及平均住院時間比較,差異均無統計學意義(P>0.05)。兩組患兒的心率整體呈下降趨勢,併且在機械通氣48 h時接近正常範圍(120~140次/min),各箇時間點整體比較差異有高度統計學意義(F=4.381,P<0.01)；呼吸次數整體呈下降趨勢,併且在機械通氣48 h點接近正常範圍(35~60次/min),各箇時間點整體比較差異有高度統計學意義(F=10.390,P<0.01)；平均動脈血壓各箇時間點整體比較差異無統計學意義(P>0.05)。 PRVC組氣道峰壓在機械通氣1、6、24 h時均低于VC組,差異均有統計學意義(P<0.05)；氧閤指數數值整體呈下降趨勢,機械通氣1 h時,PRVC組與VC組比較,差異無統計學意義(P>0.05),機械通氣6、24、48 h時差異均有統計學意義(P<0.05)；機械通氣時兩組pH值>7.45和pH值<7.35的髮生率比較,差異均無統計學意義(P>0.05)；機械通氣時兩組PCO2>60 mmHg和PCO2<35 mmHg的髮生率比較,差異無統計學意義(P>0.05)。結論與VC模式比較,PRVC模式治療NRDS時具有較低的氣道峰壓,可能降低肺氣壓傷的髮生,是一種肺保護性通氣模式。
목적：관찰압력조절용량공제(PRVC)화용량공제(VC)량충통기모식재치료신생인호흡군박종합정(NRDS)시적상관삼수변화,평고PRVC재NRDS치료중적우세。방법선택2014년5월~2015년3월양주대학의학원부속회안시부유보건원신생인의학중심주원32례신생인호흡군박종합정환인위연구대상,근거호흡궤모식선택불동분위PRVC조(PRVC모식통기,n=17)화VC조(VC모식통기48 h후개PRVC모식통기,n=15),기타적호흡궤삼수설치상동。관찰량조환인적출생체중、태령、궤계통기시간、흡양시간급평균주원시간；관찰궤계통기전、궤계통기6、24、48 h환인적호흡빈솔、심솔급평균동맥압혈압,궤계통기1、6、2、48 h적기도봉압화양합지수적변화,이급궤계통기시PH치<7.35、pH치>7.45、저탄산혈증(PCO2<35 mmHg)화고탄산혈증(PCO2약60 mmHg)적발생솔。결과32례환인균전유출원。량조환인출생체중、태령、궤계통기시간、흡양시간급평균주원시간비교,차이균무통계학의의(P>0.05)。량조환인적심솔정체정하강추세,병차재궤계통기48 h시접근정상범위(120~140차/min),각개시간점정체비교차이유고도통계학의의(F=4.381,P<0.01)；호흡차수정체정하강추세,병차재궤계통기48 h점접근정상범위(35~60차/min),각개시간점정체비교차이유고도통계학의의(F=10.390,P<0.01)；평균동맥혈압각개시간점정체비교차이무통계학의의(P>0.05)。 PRVC조기도봉압재궤계통기1、6、24 h시균저우VC조,차이균유통계학의의(P<0.05)；양합지수수치정체정하강추세,궤계통기1 h시,PRVC조여VC조비교,차이무통계학의의(P>0.05),궤계통기6、24、48 h시차이균유통계학의의(P<0.05)；궤계통기시량조pH치>7.45화pH치<7.35적발생솔비교,차이균무통계학의의(P>0.05)；궤계통기시량조PCO2>60 mmHg화PCO2<35 mmHg적발생솔비교,차이무통계학의의(P>0.05)。결론여VC모식비교,PRVC모식치료NRDS시구유교저적기도봉압,가능강저폐기압상적발생,시일충폐보호성통기모식。
Objective To observe the advantages of pressure regulated volume control (PRVC) ventilation by comparing the related parameter variables which on the PRVC ventilation and on the volume control (VC) ventilation in treatment of neonatal respiratory distress syndrome (NRDS). Methods 32 cases of neonatal respiratory distress syndrome from May 2014 to March 2015 in Neonatal Medical Center of Huai'an Maternity and Child Healthcare Hospital Affiliated to Yangzhou University Medical Academy were selected as the research objects, they were divided into the PRVC group (PRVC ventilation, n=17) and VC group (PRVC ventilation after VC mode for 48 hours instead, n=15) according to different breathing machine mode. Apart from the PRVC/VC mode, ventilator settings were comparable. The gestational age, weight, mechanical ventilation time, oxgyen cure time, hospital stay were observed. Respiratory rate, heart rate, mean arterial blood pressure were observed before and 6, 24, 48 hours after ventilation. Peak inspiratory pressure and oxygenation index were observed at 1, 6, 24, 48 hours after ventilation in both groups. The incidence of pH<7.35, pH>7.45 and low carbonate (PCO2<35 mmHg) and hyperap-nia (PCO2>60 mmHg) in two groups were compared. Results All 32 patients were recovered, there were no statistically significant differences between the two groups in the time of mechanical ventilation time, oxyen cure time, the hospitalization time (P> 0.05). Heart rates were on the de-cline as a whole, and closed to the normal range at 48 hours (120-140 times/min). There was statistically significant difference at all time points in the whole comparison (F=4.381, P< 0.01); respiratory rates were on the decline as a whole, and closed to the nor mal range at 48 hours (35-60 times/min), there was statistically significant at all time points in the whole comparison (F=10.390, P< 0.01). Mean arterial blood pressure was no statistically significant dif-ference at all time points in the whole comparison (P>0.05). Peak inspiratory pressure was lower during PRVC ventila-tion than during VC ventilation at 1, 6, 24 hours after ventilation. The PIP difference between the two groups was sta-tistically significant (P< 0.05); The oxygenation index was on the decline, there was no statistically significant differ-ence at 1 hour time point between two groups (P>0.05), but at 6,24,48 hours time points there was statistically signifi-cant between the two groups (P< 0.05). No statistically significant difference was found between the incidence of pH>7.45 and pH<7.35 when at the mechanical ventilation in two groups (P>0.05). There was no statistically significant dif-ference in the incidence of PaCO2>60 mmHg when at mechanical ventilation between two groups (P>0.05). Conclu-sion The peak inspiratory pressure was reduced on the PRVC ventilation than on the VC ventilation in the treatment of NRDS. PRVC reduced the incidence of pulmonary barotraumas probably. So it is a lung protective ventilation mode.
