不同机械通气模式与极低体重儿肺损伤的研究

Effects of different ventilation modes on the lung injury in infants with very low birth weight

目的探讨同步间歇指令通气（SIMV）与同步间歇指令通气加容量保证通气（SIMV＋VG）对早产儿肺损伤的影响。方法把30例体重≤1500g、孕周≤32周需要机械通气的肺透明膜病（hyaline membrane disease，HMD）患儿随机分为SIMV＋VG组（n=15）和SIMV模式辅助通气组（n=15）。在机械通气第1周内定期收集患儿支气管灌洗液（BALF），并立即以1200r／min离心10min。取上清液置于-70℃冰箱冷藏备测TNF-α、IL-6及IL-8的含量，由此判断肺损伤的程度。结果SIMV组发生气胸1例，支气管肺发育不良（BPD）5例，治疗后期放弃治疗3例。SIMV＋VG组发生BPD2例，无气胸发生，1例出生后15d发生严重感染，在20d死亡，2例放弃治疗。在机械通气的第1、3、5、7天，SIMV＋VG组与SIMV组BALF中TNF-α、IL-6、IL-8的含量随治疗时间的延长而增高；与SIMV＋VG相比，SIMV组增高更为明显。结论与SIMV模式相比，应用SIMV＋VG通气模式治疗早产儿HMD能较少肺损伤的产生。

Objective To compare effects of synchronized intermittent mandatory ventilation （SIMV） and SIMV plus volume - guaranteed （SIMV ＋ VG） in premature infants with hyaline membrane disease （HMD）. Method Thirty premature infants with HMD, who had birth weight ≤ 1500 g, gestational age≤ 32 weeks, and required mechanical ventilation, were randomly divided into SIMV ＋ VG group （ n = 15） or SIMV group （ n = 15）. Bronehoalveolar lavage fluid （BALF） were collected at the first week after ventilation and kept in the refrigerator at - 70 ℃ for measuring TNF-α, IL-6 and IL-8. Results In SIMV group, 1 infant developed pneumothorax, 5 infants developed bronchiopulmonaly displasia （BPD）, 3 gave up treatment in the latter period, and no infant died. In SIMV ＋ VG. group, there were no pneumothorax infants, 2 gave up treatment in the latter period, and 1 died of serious infection at 15 days and died at 20 days. At 1, 3, 5, and 7 days after ventilation, the concentrations of TNF-α, IL-6 and IL-8 in BALF were increased both in SIMV ＋ VG group and SIMV group. Compared with SIMV ＋ VG group, the concentrations of TNF-α, IL-6 and IL-8 values were significantly higher in SIMV group. Conclusions Compared with SIMV, SIMV pins volume - guaranteed in premature infants with HMD had less lung injury.