同步间歇指令通气辅以压力支持治疗新生儿呼吸窘迫综合征的应用价值

Application value of synchronized intermittent mandatory ventilation combined with pressure support treatment of neonatal respiratory distress syndrome

目的 通过观察单纯同步间歇指令通气（SIMV）与SIMV辅以压力支持（PS）对新生儿呼吸窘迫综合征（RDS）治疗效果,探讨SIMV＋PS模式的应用价值.方法 以采用SIMV＋ PS通气模式的39例RDS患儿为观察组,以单纯SIMV通气的39例RDS患儿为对照组,评估两组患儿出生后28 d内及出院或死亡时的结局.结果 观察组第28天时补氧率为41.0％,明显少于对照组的53.8％ （P ＜0.05）;观察组RDS患儿出生起至死亡或出院的最终脱机日龄为20（12 ～38）d、机械通气时间为19（10～31）d及补氧时间为20（14 ～33）d,均明显低于对照组（P＜0.05）.观察者出生后28 d内肺动脉高压,支气管肺发育不良发生率分别为明显低于对照组（P＜0.05）,而出生后28 d内死亡率及间质性肺气肿、气胸坏死性小肠结肠炎、Ⅲ和Ⅳ级脑室内出血、动脉导管未闭等并发症发病率比较,差异均无统计学意义（P＞0.05）.结论 SIMV辅以PS可在不增加呼吸做功的前提下,降低RDS的氧依赖,减少补氧时间,降低机械通气时间,对新生儿机械通气早期阶段实施保护性肺通气策略具有实用价值.

Abstract：Objective To observe treatment effect of the simple synchronized intermittent mandatory ventilation （SIMV） or SIMV supplemented with pressure support （PS） for neonatal respiratory distress syndrome （ RDS）, and to explore application of SIMV ＋ PS mode. Methods Thirty-nine cases of RDS children in the observation group used SIMV ＋ PS, and the others in control group used simple SIMV. Within 28 d after birth and at discharge or death outcomes in two groups were assessed. Results At the first 28 d observation group oxygenating rate was 39.7% , significantly less than the control group of 53.8% （P 〈 0.05 ）. In observation group from born until death or discharge RDS children＇ s, duration of mechanical ventilation and supplemental oxygen were significantly lower than those of the control group （ P 〈 0.05 ）. Pulmonary hypertension, bronchopulmonary dysplasia rates were significantly lower than the control group in observation group within 28 d （ P 〈 0.05 ） , while the differences in the mortality rate and respiratory complications such as pulmonary interstitial emphysema, pneumothorax, necrotizing enterocolitis, Ⅲ and Ⅳ grade intraventricular hemorrhage, the incidence of patent ductus arteriosus were not statistically significant （ P 〉 0.05 ）. Conclusions Without increasing the work of breathing, SIMV supplemented PS can reduce the oxygen dependence, supplemental oxygen, and duration of mechanical ventilation, which has practical value for neonatal lung protective ventilation strategy at the early stage of mechanical ventilation.