允许性高碳酸血症策略在新生儿呼吸窘迫综合征呼吸机治疗中的应用

Permissive Hypercapnia in Neonatal Respiratory Distress Syndrome with Ventilator

目的:探讨新生儿呼吸窘迫综合征(NRDS)的呼吸机治疗策略.方法:观察本院综合重症监护病房的20例NRDS均需呼吸机治疗的患儿随机分为Y、N两组,每组10人.Y组在呼吸机治疗期间,根据临床反应、血气分析结果、呼吸机参数(以降低潮气量为主)相互关系而调节,最终达pH(7.35～7.45),PaCO2(40～70)mmHg,PaO2(50～70)mmHg的允许性高碳酸血症.而N组患儿以同样的方式,维持pH 7.35～7.45,PaCO2(35～45)mmHg,PaO2(50～70)mmHg的非允许性高碳酸血症.用多功能心电监护仪持续监测心率、脉搏血氧饱和度(SpO2)并维持在85%～90%,每2h进行一次生命体征监测,入室即测动脉血气一次,随后每8 h监测一次动脉血气,呼吸机应用过程中每天床边胸片检查,病情有变化随时摄片.同时记录两组患儿FiO2、PIP、PEEP、Ti、MAP、血气分析值、呼吸机应用时间(相当于用氧时间)、住院天数.结果:两组呼吸机参数、平均气道压MAP和吸气压峰值PIP比较,P＜0.05差别有显著性.血气检测结果两组比较PaCO2差别有显著性.Y组患儿采取允许性高碳酸血症(低潮气量)使PIP降低,同时缩短Ti,结果使MAP下降,PaCO2(48±6)mmHg,呈轻度升高,而PaO2(59±16)mmHg与N组相比较无显著性,pH值为7.31±0.04,在允许范围内,心率(HR)和平均动脉压(BP)与N组相比较无明显差别.两组并发症及疗效与N组比较,P＜0.05.显示新生儿RDS呼吸机治疗时采用允许性高碳酸血症可有效缓解相关性肺损伤,降低病死率.结论:新生儿RDS呼吸机治疗时采用允许性高碳酸血症可有效缓解相关性肺损伤,降低死亡率.对NRDS后的呼吸机治疗具有临床意义.

Objective:To investigate the neonatal respiratory distress syndrome(NRDS) for the treatment of respiratory strategy.Methods: 20 NRDS,who were treated with ventilator in Intensive Care Unit,were assigned to the group Y and group N each 10 in the group Y permissive hypercapnia was induced according to clinical response,blood gas analysis,the ventilator's parameters until pH(7.35～7.45),PaCO2(40 ～70)mmHg,PaO2(50～70)mmHg at last.In the group N non-permissive hypercapnia was allowed to pH(7.35～7.45),PaCO2(35～45)mmHg,PaO2(50 ～70)mmHg.Heart rate and oxygen saturation(SaO2) were measured by multifunction ECG monitor and level of SaO2 was maintained at 85% to 90%.A vital signs,blood gas and chest X-ray were examined;and FiO2 peak inspiratory pressure(PIP),PEEP,Ti,MAP were recorded in two groups.Results:The level of MAP and PIP had difference between ventilator parameters and the average N airway pressure(P<0.05).There was a significant difference of PaCO2compared that with group N In group Y,decreased PIP and MAP,short Ti and less increased PaCO2 were found.No difference of PaO2(59±16),HR and BP compared with the N group.Conclusions: Treatment of permissive hypercapnia in NRDS with ventilator can release lung injury event and decrease the mortality of children with RDS in clinic.