新生儿机械通气撤机时呼吸力学指标的测定及临床意义

The measurement of respiratory mechanics and clinical significance on weaning ventilators in mechanically ventilated newborns

目的探讨新生儿机械通气撤机时呼吸力学指标的范围及临床意义。方法通过Bi-core-CP 100呼吸功能监测仪测定32例新生儿机械通气撤机时在CPAP模式、脱机拔管前及拔管后20min等条件下的呼吸力学指标范围,根据拔管48 h内是否重新插管分为撤机成功组与失败组。结果成功组的呼吸力学范围为:Rawmean(93.7±14.3)cmH2O/(L.s)、Crs(0.65±0.09)ml/(cmH2O.kg)、WOBp(1 589±133.2)g.cm/(min.kg);失败组为:Rawmean(98.6±15.5)cmH2O/(L.s)、Crs(0.57±0.08)ml/(cmH2O.kg)、WOBp(1 782±148.6)g.cm/(min.kg)。Crs与WOBp两组差异有显著性。撤机后拔管前两组平均WOBp为(1 846±179.1)g.cm/(min.kg),Crs为(0.624±0.11)ml/(cmH2O.kg)。脱机成功率为81.25%。结论呼吸力学的检测对新生儿呼吸机的撤离有指导作用,特别是呼吸系统顺应性和呼吸功的检测更具有实质意义。

Objective To explore the range of respiratory mechanics on weaning ventilators in mechanical ventilated newborns and its clinical significance. Methods The indixes of respiratory mechanics were measured by Bicore CP-100 pulmonary monitor in 32 ventilated newborns. The t were done in CPAP（ continuous positive airways pressure）（3cmH20）, Weaned ventilator before extubation, 20 minutes afuer extubation. Extubation success or failure was defined as reintubation within 48 hours of extubation. Results The range of respiratory mechanics in succeed weaning group were Rawrnean（ mean airway resistance）（93.7 ± 14.3） cmH2O/（ L· s）, Crs（ respiratory system compliance） （0.65 ± 0.09） ml/（ cmH2O· kg）, WOBp （ work of breathing, patient） （ 1 589 ± 133.2）g·cm/（ min·kg） ; The failure group were Rawrnean（98.6±15.5）cmH20/ （L·s）, Crs（0.57 ±0.08）ml/（ cmH2O·kg）, WOBp （ 1 782 ± 148.6） g·cm/（ min·kg）. There were significant differences between the two groups in Crs and WOBp. The mean WOBp and Crs of two groups in Weaned ventilator before extubation were （ 1 846 ± 179.1 ） g·cm/（ min. kg）, （0.624 ± 0.11 ） ml/（ cmH2O · kg）. The success rates were 81.25% . Conclusion Bedside measurements of improved respiratory mechanics（WOBp, Crs）can predict success or failure withdrawal of mechanical ventilation in neonates. Pulmonary function testing criteria may be useful in determining optimal time of extubation in infants.