肺保护性通气策略在新生儿机械通气中的应用研究(1)
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[摘要] 目的：观察用肺保护性通气策略和呼吸力学监护指导新生儿呼吸衰竭的机械通气，以降低呼吸机相关性肺损伤。方法：回顾性分析我院2008年2月~2010年12月收治入院的30例急性呼吸衰竭的早产儿，随机分为机械通气组(对照组)和保护性机械通气组(观察组)，观察两组治疗前后潮气量(VT)、呼吸道峰压(PIP)、呼气末正压(PEEP)、呼吸频率(RR)及血气分析结果。结果：本研究中两组所有患儿均治愈，顺利撤机。两组患儿治疗后呼吸机参数比较，观察组VT(8.2±0.9)ml/kg、PIP(35.1±3.8)cm H2O(1 cm H2O=0.098 kPa)，对照组VT(10.5±0.5)ml/kg、PIP(45.5±3.7)cm H2O，两组VT、PIP比较，差异有高度统计学意义(P<0.01)；观察组采用允许性高碳酸血症，平均PaCO2值高于对照组，差异有高度统计学意义(P<0.01)；对照组呼吸机相关性肺损伤(VILI)的发生率为33.33%(5/15)，观察组VILI的发生率为13.33%(2/15)，两组比较差异有统计学意义(P<0.05)。结论：早产儿的保护性机械通气能够有效治愈患儿的呼吸衰竭，而且并发症相对较少。
[关键词] 早产儿；机械通气；保护性策略
[中图分类号] R722.1 [文献标识码] A [文章编号] 1673-7210(2011)11(a)-072-03
Study on the application of the lung protective ventilation strategy in neonatal mechanical ventilation
GUO Yunze
Department of Pediatrics, the People's Hospital of Wei County, Hebei Province, Weixian 056800, China
[Abstract] Objective: To guide mechanical ventilation of neonatal respiratory failure with lung protective ventilation strategy and respiratory mechanics monitoring, and reduce ventilator-associated lung injury. Methods: 30 case of premature infant with acute respiratory failure in our hospital from February 2008 to December 2010 were randomly divided into mechanical ventilation group (control group) and the protection of the mechanical ventilation group (observation group). The tidal volume (VT), peak airway pressure (PIP), end-expiratory upright (PEEP), respiratory rate (RR) and blood gas analysis results before and after treatment were observed. Results: All patients were cured in both groups and wean smooth, the differences of VT, PIP after treatment in observation group [VT(8.2±0.9) ml/kg, PIP(35.1±3.8)cm H2O] (1 cm H2O=0.098 kPa)and control group [VT(10.5±0.5) ml/kg, PIP(45.5±3.7)cm H2O] were compared, and there was a significant difference between them (P<0.01). Observation group were treated with permissive hypercapnia, the average PaCO2 was significantly higher than that of the control group (P<0.01); The incidence of VILI in control group was 33 ......
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