不同通气模式对呼吸窘迫综合征早产儿心功能的影响

Influence of Different Ventilation Methods on Cardiac Function in Premature Infants with Respiratory Distress Syndrome

目的探讨早产儿在相同呼气末正压(PEEP)水平下经鼻持续呼吸道正压(N-CPAP)模式和同步间歇正压通气(SIPPV)模式对心功能的影响。方法选择本院新生儿重症监护病房2009年3月-2011年5月收治的80例早产儿进行配对分析。其中N-CPAP治疗的20例急性呼吸窘迫综合征(RDS)患儿和SIPPV治疗的20例RDS患儿作为病例组(共40例),另外40例同期住院的一般疾病患儿按胎龄和日龄与病例组配成40对,应用彩色多普勒超声心动图检测所有患儿心脏泵血功能指标及各瓣口流速指标,比较2种通气模式对早产儿心功能指标的差异及2种不同通气方式下相同PEEP水平对早产儿心功能的影响。结果 N-CPAP组患儿肺动脉瓣口峰值流速,主动脉瓣口峰值流速,二、三尖瓣E/A值,射血分数,心排出量的均值均低于其配对组患儿,但差异均无统计学意义(Pa>0.05);SIPPV组患儿以上指标均值亦低于其配对组,其中肺动脉瓣口峰值流速,二、三尖瓣E/A值差异均有统计学意义(Pa<0.05);N-CPAP组与SIPPV组比较,SIPPV组各项心功能指标均值均低于N-CPAP组,其中对于三尖瓣E/A值的影响更明显,2组比较差异有统计学意义(0.71±0.05 vs 1.85±0.64,P<0.05)。结论 N-CPAP对早产儿心功能的影响不明显;SIPPV主要影响全心舒张功能、肺动脉及主动脉瓣峰值流速;相同PEEP水平下,SIPPV与N-CPAP相比,SIPPV主要影响早产儿的三尖瓣E/A值及右心室舒张功能。

Objective To investigate the influence on cardiac function in premature infants ventilated through nasal continuous positive airway pressure（N-CPAP） and synchronized intermittent positive pressure ventilation（SIPPV） in the same positive end-expiratory pressure（PEEP）.Methods Eighty premature infants were selected for case-control study,20 premature infants with respiratory distress syndrome（RDS） treated with N-CPAP and another 20 premature infants with RDS treated with SIPPV were assigned as the observation group,and then they were divided into N-CPAP group and SIPPV group.In addition,40 premature infants with normal cardiac function were matched with gestational age and day age as the control group.The cardiac function indexes were monitored by color Doppler echocardiography in all groups.The difference of cardiac function indexes were compared between N-CPAP group,SIPPV group and the matched groups.Results Peak flow rate of aorta valve orifice（AV）,peak flow rate of pulmonary artery valve orifice（PV）,the ratio of early（E） and late（A） diastolic velocities of mitral and tricuspid valves（MV-E/A,TV-E/A）,ejection fraction（EF）,cardiac output（CO） in N-CPAP group were lower than the corresponding matched group,but the indexes were not significantly different between 2 groups（Pa0.05）.The PV,E/A of mitral and tricuspid valves obviously lower in the SIPPV group than its corresponding matched group（Pa0.05）.The E/A of tricuspid valves in SIPPV group was 0.71±0.05,while 1.85±0.64 in the N-CPAP group,there was significant difference between 2 groups（P0.05）.Conclusions N-CPAP has a little influence on the cardiac function of premature infants;SIPPV has influence on PV,AV and diastolic function of left and right ventricular.Under the same PEEP,SIPPV has great effect on diastolic function of right ventricular compared with N-CPAP.