比例辅助通气叠加同步间歇指令通气治疗新生儿呼吸衰竭临床观察

Clinical observation on PAV plus SIMV in the treatment of neonatal respiratory failure

目的观察比例辅助通气（PAV）叠加同步间歇指令通气（SIMV）治疗新生儿呼吸衰竭的临床效果。方法95例呼吸衰竭新生儿，采用PAV＋SIMV叠加模式进行机械通气治疗，通气过程中，以维持患儿的脉搏血氧饱和度（SpO2，85％-95％）和呼气末二氧化碳分压（PETCO2，30～45mmHg）为目标调节呼吸机参数。观察患儿心率、动脉血气、氧合指数（oI）及呼吸机参数等变化。结果91例患儿痊愈出院，4例放弃治疗，治愈率为95．8％。平均通气时间（97．3±8．5）h，平均吸氧时间（7．1±1．7）天，平均住院时间（18．2±6．5）天。机械通气后，患儿心率、呼吸频率明显减慢（P〈0．05），渐接近正常或者正常；患儿各个时间点的pH、动脉氧分压（PaO2）和动脉二氧化碳分压（PaCO2）数值均在正常范围内，各时点间整体比较差异无统计学意义（P均〉0．05）；患儿0I随时间延长逐步减小，各时点间整体比较差异有统计学意义（P〈0．05）。结论PAV叠加SIMV通气模式在新生儿呼吸衰竭治疗中具有一定的临床应用价值。

Objective To observe the effect of proportional assist ventilation （PAV） plus synchronized intermittent mandatory ventilation （SIMV） in treating neonatal respiratory failure （NRF）. Methods 95 cases of neonatal respiratory failure （NRF） who required mechanical ventilation were treated by PAV plus SIMV model. During ventilation, ventilator parameters were adjusted according to pulse blood oxygen saturation （ SpO2, maintained at 85% - 95% ） and partial pressure of end- tidal carbon dioxide （PETCO2, maintained at 30 -45 mmHg）. Heart rate （HR）, resporatory rate （RR） , oxygenation index （OI） , blood gas analysis values, and some important ventilator parameters of the ventilator were observed. Results 91 cases were cured, the other4 cases gave up treatment and automatically discharged. The recovery rate was 95.8%. The mean mechanical ventilation time was （97.3 ±8.5 ） hours, the mean oxygen inhalation time was （7.1 _＋ 1.7 ） days, the mean hospital stay was （ 18.2 ±6.5 ） days. After the treatment of PAV plus SIMV, HR and RR were significantly slower （ P 〈 0.05 ） , which were nearly normal or normal, pH, PaCO2 , and PaO2 were in the normal range at all time points, with no significant differences （ all P 〉 0.05 ）. OI decreased quickly as time passed by and there were statistically significant differences at each time point （ P 〈 0.05 ）. Conclusion The PAV plus SIMV shows certain value in clinical application for the treatment of NRF.