摘要
目的分析比较压力控制+同步间歇性指令通气(PCV+SIMV)模式与容量目标压力控制+同步间歇性指令通气(VTPC+SIMV)模式治疗新生儿呼吸窘迫综合征(NRDS)的应用价值。方法回顾性分析我院2018年2月~2019年12月行机械通气治疗的86例NRDS患儿临床资料,其中45例经VTPC+SIMV模式通气(VTPC组),41例经PCV+SIMV模式通气(PCV组)。记录两组肺表面活性剂(PS)使用情况及机械通气时间、机械通气后吸氧时间、住院时间;并比较两组机械通气前及通气6 h后血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))],机械通气6、24 h呼吸力学指标[肺动态顺应性(Crs)、肺泡动脉氧分压差(PA-aO_(2))、呼吸指数(RI)]差异;并分析机械通气6 h后血气分析指标与呼吸力学指标的相关性;记录两组并发症发生情况。结果VTPC组PS使用次数、机械通气时间、机械通气后吸氧时间、住院时间均低于PCV组(均P<0.05)。机械通气6 h后,两组PaO_(2)均较通气前升高(P<0.05),且VTPC组高于PCV组(P<0.05);PaCO_(2)则较通气前降低(P<0.05),且VTPC组低于PCV组(P<0.05)。机械通气24 h后,两组Crs均较机械通气6 h后升高(P<0.05),PA-aO_(2)、RI则较机械通气6 h后降低(P<0.05);且机械通气6、24 h后,VTPC组Crs高于PCV组(P<0.05),PA-aO_(2)、RI低于PCV组(P<0.05)。经Pearson相关性分析,发现机械通气6 h后PaO_(2)与Crs呈正相关(P<0.05),与PA-aO_(2)、RI呈负相关(P<0.05);PaCO_(2)与Crs呈负相关(P<0.05),与PA-aO_(2)、RI呈正相关(P<0.05)。VTPC组并发症总发生率低于PCV组(P<0.05)。结论在NRDS治疗中,与PCV+SIMV模式相比,VTPC+SIMV模式具有更高的疗效及安全性,是一种较为理想的肺保护性通气模式。
Objective To analyze and compare the application value of pressure control+synchronized intermittent mandatory ventilation(PCV+SIMV)model,volume target pressure control+synchronized intermittent mandatory ventilation(VTPC+SIMV)model in the treatment of neonatal respiratory distress syndrome(NRDS).Methods The clinical data of 86 children patients with NRDS who underwent mechanical ventilation in our hospital were retrospectively analyzed.Among them,45 cases were ventilated with VTPC+SIMV model(VTPC group)and 41 cases were ventilated with PCV+SIMV model(PCV group).The use of pulmonary surfactant(PS),mechanical ventilation time,oxygen inhalation time after mechanical ventilation and hospital stay were recorded in the two groups,and the blood gas analysis indexes[arterial partial pressure of blood oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))]before mechanical ventilation and after 6 h of ventilation and respiratory mechanics indexes[pulmonary dynamic compliance(Crs),alveolar artery partial pressure difference(PA-aO_(2)),respiratory index(RI)]after 6h and 24h of mechanical ventilation were compared between the two groups.The correlation between blood gas analysis indexes and respiratory mechanics indexes after 6 h of mechanical ventilation was analyzed,and the occurrence of complications were recorded in the two groups.Results The number of PS use,mechanical ventilation time,oxygen inhalation time after mechanical ventilation and hospital stay in VTPC group were lower than those in PCV group(P<0.05).After 6 h of mechanical ventilation,the PaO_(2) in the two groups was higher than that before ventilation(P<0.05),and the index in VTPC group was higher than that in PCV group(P<0.05).The PaCO_(2) was lower than that before ventilation(P<0.05),and the index in VTPC group was lower than that in PCV group(P<0.05).After 24 h of mechanical ventilation,the Crs in the two groups was higher than that after 6 h of mechanical ventilation(P<0.05)while the PA-aO_(2) and RI were lower than those after 6 h of mechanical ventilation(P<0.05).After 6h and 24h of mechanical ventilation,the Crs in VTPC group was higher than that in PCV group(P<0.05)while the PA-aO_(2) and RI were lower than those in PCV group(P<0.05).Pearson correlation analysis showed that PaO_(2) after 6 h of mechanical ventilation was significantly positively correlated with Crs(P<0.05),and was significantly negatively correlated with PA-aO_(2) and RI(P<0.05).PaCO_(2) was significantly negatively correlated with Crs(P<0.05),and was significantly positively correlated with PA-aO_(2) and RI(P<0.05).The total incidence rate of complications in VTPC group was lower than that in PCV group(P<0.05).Conclusion In NRDS treatment,compared with PCV+SIMV model,VTPC+SIMV model has higher efficacy and safety,and is an ideal lung protective ventilation model.
作者
王成
段玉松
叶盎然
李雪莲
刘怡汐
WANG Chen;DUAN Yusong;YE Angran;LI Xuelian;LIU Yixi(Department of Pediatrics,The Third People′s Hospital of Mianyang,Sichuan Mental Health Center,Mianyang 621000,Sichuan,China)
出处
《西部医学》
2022年第4期580-584,共5页
Medical Journal of West China
基金
四川省卫生和计划生育委员会科研项目(18PJ015)。
