新生儿呼吸窘迫综合征呼吸力学动态监测及临床意义

Respiratory mechanics dynamically monitoring in neonates with severe respiratory distress syndrome and its clinical significance

目的 探讨新生儿呼吸窘迫综合征 (NRDS)呼吸力学特征及其与临床的关系。方法 对 17例机械通气下NRDS儿进行了呼吸力学指标、X线胸片及血气分析检测。结果 呼吸系统顺应性 (Crs)与NRDS病情严重程度及预后有关 ,Crs<0 .3ml/ (cmH2 O·kg)示病情严重 ,Crs <0 .2ml/ (cmH2 O·kg)病死率高 ;Crs与氧合指数 (OI)呈负相关关系 (r =- 0 .948) ,有直线回归关系 :OI =6 4.73～ 82 .70Crs。X线分级与Crs呈负相关关系 (r =- 0 .76 8) ,Crs为0 .6 8± 0 .11ml/ (cmH2 O·kg)时脱机成功率为 90 .9%。结论 对RDS患儿Crs及其动态变化进行监测 ,可以判断RDS患儿病情 ,指导呼吸机治疗 。

Objective To study the character of respiratory mechanics in severe respiratory distress syndrome and its clinical significance. Methods We measured the indices of respiratory mechanics, chest radiographs and blood gas in 17 newborns with respiratory distress syndrome(RDS). Results The indices of respiratory mechanics in 17 newborns with RDS showed:compliance of respiratory system ( Crs ) was correlated with severity and outcome of the illness. Crs lower than 0.3 ml/(cmH 2O·kg) indicated severe illness. Crs lower than 0.2 ml/(cmH 2O·kg) was associated with high mortality rate. Crs were negatively correlated with oxygenated index(OI)(r=-0.948) and a linear regression relation was found (OI=64.73～82.70Crs). Chest X ray manifestations negatively correlated with Crs (r=-0.768). 90.9 % of the patients were successfully weaned from the ventilator when mean value of Crs was 0.68±0.11 ml/(cmH 2O·kg). Conclusion Crs monitoring is of clinical significance in evaluating the severity of RDS, directing mechanical ventilation management, reducing frequency of blood gas analysis and radiographs, and predicting outcome.