新生儿呼吸窘迫综合征上机后呼吸性碱中毒的临床分析

Clinical analysis of respiratory alkalosis about the respiratory distress syndrome of newborn after using mechanical ventilation

目的:了解我科患有呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的新生儿使用呼吸机后呼吸性碱中毒(简称呼碱)发生情况,分析其原因及不良影响,并探讨其预防的方法。方法:回顾性分析在我院新生儿NICU使用呼吸机治疗的22例NRDS患儿,共有血气分析79次,将患儿分为呼碱组(31次),非呼碱组(48次)。比较不同性别、孕周、体重、上机时间及使用肺泡表面活性物质(PS)后的呼碱发生率;两组呼吸机参数的差异,了解呼碱发生的情况,分析其发生的原因,进行Logistic回归分析。结果:(1)共分析血气79份,呼碱31份,占39.2%。(2)使用PS呼碱发生率显著增高。经Logistic回归分析显示,PIP及RR是呼碱的危险因素。结论:NRDS患儿,使用呼吸机,尤其是使用PS后呼碱发生率增高;PIP及RR增高是呼碱发生的高危因素;注意复查血气,及时下调PIP及RR,避免呼碱的发生。

Objective： To know the ocurrence of respiratory alkalosis after using mechanical ventilation among the newborns with neonatal respiratory distress syndrome（ NRDS） in my departments,then analyze its causes and adverse effects,and to discuss its prevention measures. Methods： A retrospective analysis of22 NRDS newborns in our NICU with ventilator treatment were conducted. In the total of 79 times of blood gas analyses,newborns were divided into call respiratory alkalosis group（ 31 times）,non respiratory alkalosis group（ 48 times）. Different sexes,gestational weeks,weight,the time of using mechanical ventilation and the incidence rate of alkali after using the pulmonary alveolar surface active substances（ PS） of both groups were compared; differences of alkali ventilator parameters in both groups were compared to learn and analyze the respiratory alkalosis produced and its causes,and then they were under logistic regression analysis. Results：（1） 79 cases of blood gas were analyzed,Analysis of blood gas 79 copies,of which 31 cases were call respiratory alkalosis alkali,accounting for 39.2%.（2） Incidence rate of call respiratory alkalosis was significantly higher after using PS. Logistic regression analysis showed that PIP and RR were the risk factors of call respiratory alkalosis. Conclusion： For the newborns with NRDS,the incidence rate of call respiratory alkalosis will rise after using mechanical ventilation and especially after using PS. The increased PIP and RR may be the high risk factor for the occurrence of call respiratory alkalosis. Therefore,paying attention to reviewing blood gas,and reducing PIP and RR in time may avoid the happening of call respiratory alkalosis.