压力调节容量控制通气与同步间歇指令通气在治疗新生儿呼吸窘迫综合征中的比较

Comparison study of pressure regulated volume control ventilation and synchronized intermittent mandatory ventilation in treating neonates with respiratory distress syndrome

目的观察压力调节容量控制通气（PRVC）和同步间歇指令通气（SIMV）通气在治疗呼吸窘迫综合征（RDS）新生儿时相关参数的变化。方法 2013年6月～2014年3月在淮安市妇幼保健院新生儿医学中心出生的,患有呼吸窘迫综合征且需要机械通气58例新生儿,分为PRVC组（32例,采用PRVC通气）和SIMV组（26例,采用SIMV通气）。观察两组机械通气时间、氧疗时间、住院时间、动脉氧分压/肺泡氧分压;观察两组机械通气时酸血症、碱血症、低碳酸血症和高碳酸血症的发生率;观察两组机械通气前、机械通气1、12、24、48、72 h的心率（HR）、呼吸频率（RR）、平均动脉血压（MABP）、气道峰压（PIP）、氧合指数（OI）等变化。结果①58例RDS新生儿均治愈出院。两组机械通气时间、氧疗时间、住院时间、气胸发生率、颅内出血发生率、支气管发育不良发生率和呼吸机相关性肺炎发生率比较,差异均无统计学意义（P〉0.05）。②两组的HR和RR变化均呈下降趋势,在机械通气72 h时接近正常范围。两组平均动脉血压变化均在正常范围。③两组PIP变化均呈下降趋势。PRVC组内各个时间点之间PIP比较、SIMV组内各个时间点之间PIP比较,差异均有统计学意义（P〈0.05）;PRVC组PIP在机械通气1、12、24、48、72 h均低于SIMV组,差异有统计学意义（P〈0.05）。④两组OI变化均呈下降趋势。PRVC组内各个时间点OI值比较、SIMV组内各个时间点之间OI值比较,差异有统计学意义（P〈0.05）。PRVC组在机械通气1、12、24、48 h的OI值与SIMV组比较,差异均无统计学意义（P〉0.05）。PRVC组OI在机械通气72 h时低于SIMV组,差异有统计学意义（P〈0.05）。⑤机械通气时pH值〈7.35发生率（PRVC组为16.5%、SIMV组为13.5%）和pH值〉7.45发生率（PRVC组为7.8%、SIMV组为5.2%）比较,差异无统计学意义（P〉0.05）。PRVC组动脉二氧化碳分压（PaCO2）〈35 mm Hg的发生率低于SIMV组,差异均有统计学意义（P〈0.05）;两组机械通气时PaCO2〉60 mm Hg发生率比较,差异无统计学意义（P〉0.05）。结论 RDS新生儿的呼吸支持中,在获得相同的疗效情况下,与SIMV模式比较,PRVC模式下PIP和过度通气的发生率显著降低;PRVC模式可能具有一定的临床应用价值,值得推广。

Objective To observe the changes of related parameter of neonates with respiratory distress syndrome（RDS）ventilated by pressure regulated volume control ventilation（PRVC） and synchronized intermittent mandatory ventilation（SIMV）. Methods From June 2013 to March 2014, in Maternity and Child Health Care Hospital of Huai＇an City, 58cases of neonates with respiratory distress syndrome（RDS） who required mechanical ventilationwere were divided into PRVC group（32 cases, ventilated by PRVC） and SIMV group（26 cases, ventilated by SIMV）, and the values of related clinical and respirator parameters were recorded and analyzed. The mechanical ventilation time, oxygen cure time, hospital stay and arterial oxygen partial pressure/alveolar oxygen partial pressure. The incidence of acidemia, alkalemia and low carbonate and hypercapnia in two groups were observed. The changes of heart rate（HR）, respiratory rate（RR）, mean arterial blood pressure（MABP）, peak inspiratory pressure（PIP） and oxygenation index（OI）when at mechanical ventilation for 1, 12, 24, 48 and 72 hours in two groups were observed. Results ①All 58 cases of neonates with respiratory distress syndrome（RDS） were recovered, there were no statistically significant differences between the two groups in the time of mechanical ventilation, oxygen therapy time, the hospitalization time, the incidence of intracranial bleeding, the incidence of bronchial dysplasia and the incidence of ventilator-associated pneumonia（P〉0.05）. ②The changes of HR and RR showed downtrend, and were in the normal range at mechanical ventilation for 72 hours in two groups. The changes of MABP in the two groups were in normal range. ③ The changes of PIP showed downtrend in two groups. PIP at the different time in the different group were compared, the differences were statistically significant（P〈0.05）. PIP in PRVC group were lower than those in SIMV group at mechanical ventilation for 1,12, 24, 48 and 72 hours, the differences were statistically significant（P〈0.05）. ④The changes of OI showed downtrend. OI at the different time in the different group were compared, the differences were statistically significant（P〈0.05）. in PRVC group were compared with those in SIMV group at mechanical ventilation for 1, 12, 24, 48 hours, the differences were not statistically significant（P〉0.05）. OI in PRVC group was lower than that in SIMV group at mechanical ventilation for 72 hours, the difference was statistically significant（P〈0.05）. ⑤There was no statistically significant difference between two groups in the incidence of pH7.35（PRVC group was 16.5%, SIMVwas 13.5%） and pH7.45（PRVC group was 7.8%, SIMV was 5.2%） when at the mechanical ventilation（P〉0.05）. The incidence of PaCO235 mm Hg in PRVC group was lower than that in SIMV group at mechanical ventilation, the difference was statistically significant（P〈0.05）. There was no statistically significant difference between two groups in the incidence of PaCO260 mm Hg when at mechanical ventilation（P〉0.05）. Conclusion In the case to achieve the same of effect, the PIP and the incidence of hyperventilation in PRVC mode are significantly lower than that of in SIMV mode. So the PRVC mode may has some certain value in clinical application and worth of promotion.