手动通气和机械通气对ARDS早产儿肺表面活性物质给药过程中脑氧代谢的影响

Influence of manual ventilation and mechanical ventilation on cerebral oxygen metabolism during pulmonary surfactant administration in preterm infants with acute respiratory distress syndrome

目的探讨手动通气和机械通气对急性呼吸窘迫综合征（ARDS）早产儿肺表面活性物质（PS）给药过程中脑氧代谢的影响。方法将54例ARDS早产儿根据随机数字表法分为2组,每组27例。手动通气组在PS给药过程中采用气管导管连接气囊,手动按压通气;机械通气组在PS给药过程中采用气管导管连接呼吸机,机械通气。在用药前、用药期间及用药后5min、10min分别监测2组脑氧饱和度（ScO2）的变化及平均动脉压（MABP）情况。结果用药期间及用药后5min,机械通气组及手动通气组的ScO2均较用药前明显增加（t值分别为6.722、5.399、5.841、4.642,P值均为0.000）;用药后10min2组ScO2水平与用药前比较差异无统计学意义。手动通气组用药期间及用药后5min的rScO2-MABP显著高于机械通气组（t值分别为5.212、4.169,P值均为0.000）;手动通气组用药期间及用药后5min的rScO2-MABP均较用药前明显增加（t值分别为9.866、4.133,P值均为0.000）;机械通气组用药期间的rScO2-MABP较用药前明显增加（t=5.278,P=0.000）,用药后5minrScO2-MABP与用药前比较差异无统计学意义。结论在ARDS早产儿PS给药过程中采用手动通气和机械通气方式均可使ScO2短暂升高,且ScO2变化趋势大致相同,而机械通气对脑血管自主调节功能影响较小。

Objective To investigate the effects of manual ventilation and mechanical ventilation on cerebral oxygen metabolism during pulmonary surfactant administration in preterm infants with acute respiratory distress syndrome （ARDS）. Methods 54 ARDS preterm infants were divided into two groups according to the random number table method, with 27 cases in each group. The tracheal tube was used to connect the balloon in the manual ventilation group, manually pressing for ventilation. The tracheal tube was used to connect the ventilator in the mechanical ventilation group. The changes of cerebral oxygen saturation （SCO2） and mean arterial pressure （MABP） were monitored before treatment, during treatment,at five minutes and ten minutes after treatment. Results Compared with before treatment, ScO2 in mechanical ventilation group and manual ventilation group obviously increased during treatment and at five minutes after treatment （t = 6.722, 5.399, 5.841, 4.642, all P =0.000）. There was no significant difference in ScO2 of the two groups between at ten minutes after treatment and before treatment. The rSoO2-MABP was significantly higher in the ventilation group than that in the mechanical ventilation group during treatment and at five minutes after treatment （ t = 5. 212,4. 169, all P = 0. 000）. The rSoO2-MABP in the manual ventilation group during treatment and at five minutes after treatment was significantly increased compared with that before treatment （t ： 9.866, 4. 133, all P = 0.000）. In the mechanical ventilation group, rSoO2-MABP during treatment was significantly higher than that before treatment （ t = 5. 278, P = 0. 000）, there was no significant difference between at five minutes after treatment and before treatment. Conclusions Both manual ventilation and mechanical ventilation can increase ScO2 transiently during pulmonary surfactant administration in preterm infants with ARDS, and the changes of ScO2 are similar. However, mechanical ventilation has little effect on the autonomic regulation of cerebrovascular.