容量目标通气治疗新生儿呼吸窘迫综合征的疗效

Efficacy of volume-targeted ventilation for the treatment of neonatal respiratory distress syndrome

目的观察容量目标通气（VTV）治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法将2013年8月至2015年8月52例NRDS患儿随机分为VTV组和压力控制通气（PCV）2组,每组26例。VTV组采用A/C＋Vc＋模式,PCV组采用A/C＋PCV模式。试验开始后6、24、48h检查动脉血气分析,观察有创通气时间、氧疗时间、病死率以及低碳酸血症、气胸、呼吸机相关性肺炎（VAP）、Ⅲ~Ⅳ级脑室周围-脑室内出血（PVH-IVH）、脑室周围白质软化（PVL）、支气管肺发育不良（BPD）、早产儿视网膜病变（ROP）的发生率。结果 VTV组有创通气时间较PCV组短（P〈0.05）,低碳酸血症、VAP、PVL的发生率均低于PCV组（P〈0.05）,而两组吸氧时间、病死率、气胸和Ⅲ~Ⅳ级PVH-IVH以及BPD、ROP的发生率差异无统计学意义。结论 VTV治疗NRDS的疗效优于PCV,值得临床推广应用。

Objective To investigate the efficacy of volume-targeted ventilation（VTV） for the treatment of neonatal respiratory distress syndrome（NRDS）. Methods Fifty-two neonates with NRDS between August 2013 and August 2015 were randomly divided into two groups： VTV and pressure-controlled ventilation（PCV）（n=26 each）. A/C＋Vc＋ ventilation model was applied in the VTV group, and A/C＋PCV ventilation model was applied in the PCV group. Arterial blood gas analysis was performed at 6, 24, and 48 hours after ventilation. The following parameters were observed： time of invasive ventilation, duration of oxygen therapy, mortality, and the incidence rates of hypocapnia, pneumothorax, ventilator-associated pneumonia（VAP）, grade III-IV periventricular-intraventricular hemorrhage（PVHIVH）, periventricular leukomalacia（PVL）, bronchopulmonary dysplasia（BPD）, and retinopathy of prematurity（ROP）. Results Compared with the PCV group, the VTV group had a significantly shorter time of invasive ventilation（P0.05） and significantly lower incidence rates of hypocapnia, VAP, and PVL（P0.05）; however, there were no significant differences in the duration of oxygen therapy, mortality, and incidence rates of pneumothorax, grade Ⅲ~Ⅳ PVH-IVH, BPD, and ROP. Conclusions VTV has a better efficacy than PCV in the treatment of NRDS, and is worthy of clinical promotion and application.