不同机械通气方式对新生儿脑血流的影响及临床意义

Effects of different mechanical ventilation methods on cerebral blood flow of neonates and the clinical significance

目的:探讨气管插管机械通气和经鼻CPAP(nCPAP)对新生儿脑血流的影响及临床意义。方法:采用经颅多普勒超声诊断仪监测气管插管机械通气和nCPAP新生儿脑血流变化,并与同期健康足月儿做对照。结果:气管插管机械通气组脑血流参数在第1天和第2天与对照组比较,差异均有统计学意义(P<0.05),而nCPAP组在第1～3天与对照组比较,差异均无统计学意义(P>0.05);气管插管机械通气组在第2天脑血流异常率为20.0%(6/30),明显高于nCPAP组的3.3%(1/30)(P<0.05);机械通气60例新生儿最终经临床诊断有6例脑损伤,其中在第3天4例脑血流异常新生儿均被证实有脑损伤,第2天7例脑血流异常新生儿有5例被证实存在脑损伤。结论:气管插管呼吸机辅助通气对新生儿脑血流有明显影响,应尽量选择鼻塞式CPAP辅助通气,减少脑损伤的发生。

Objective：To explore the effects of mechanical ventilation by endotracheal intubation and nasal continuous positive airway pressure（nCPAP） on cerebral blood flow of neonates and the clinical significance. Methods：Transcranial Doppler ultrasonography was used to monitor the changes of cerebral blood flow of neonates receiving mechanical ventilation by endotracheal intubation and mechanical ventilation by nCPAP,then the results were compared with those of healthy full-term neonates at the same period. Results：There was significant difference in cerebral blood flow indexes on the first day and the second day between endotracheal intubation group and control group（P〈0.05）,but there was no significant difference in cerebral blood flow indexes on the first day,the second day and the third day between nCPAP group and control group（P〉0.05）;the abnormal rate of cerebral blood flow on the second day in endotracheal intubation group was 20.0%（6 /30）,which was significantly higher than that in nCPAP group [3.3%（1/30）]（P〈0.05）;among 60 neonates receiving mechanical ventilation by endotracheal intubation,6 neonates were diagnosed as cerebral injury,on the third day,4 neonates with abnormal cerebral blood flow were confirmed with cerebral injury;on the second day,5 neonates were confirmed with cerebral injury among 7 neonates with abnormal cerebral blood flow. Conclusion：Mechanical ventilation by endotracheal intubation has an obvious impact on cerebral blood flow of neonates,nCPAP should be advocated in order to reduce the occurrence of cerebral injury.