间歇正压通气对极低出生体重儿有创呼吸机脱机拔管的价值

Value of intermittent positive pressure ventilation for the extubation of invasive ventilators in extremely low birth weight infants

目的探讨间歇正压通气对极低出生体重儿有创呼吸机脱机拔管的临床价值。方法选择极低体重儿80例,按照随机数字表法分为观察组和对照组,各40例。观察组患儿在拔除气管导管后立即使用婴儿呼吸机进行经鼻间歇正压通气,对照组给予面罩呼吸机无创通气。比较两组机械通气情况、治疗后血气分析各指标、乳酸水平、不良反应发生情况。结果观察组机械通气时间、拔管后呼吸暂停时间及拔管后发绀持续时间均显著短于对照组(P<0.05)。与对照组比较,观察组p H、PO2更高,PCO2及乳酸水平更低(P<0.05)。观察组呼吸道干燥发生率明显低于对照组(P<0.05);两组腹胀、胃潴留及返流发生率比较,差异无统计学意义(P>0.05)。结论鼻塞间歇正压通气能显著逆转极低出生体重儿缺氧及二氧化碳蓄积,利于顺利撤离有创呼吸机,且不增加不良反应。

Objective To investigate the clinical value of intermittent positive pressure ventilator for extubation of invasive ventilators in extremely low birth weight infants. Methods Eighty cases of extremely low birth weight infants were selected and divided into observation group and control group according to the random number table method, with 40 cases in each group. The infants in the observation group were treated with intermittent positive pressure ventilation using baby ventilator immediately after removal of the tracheal tube, and the control group was treated with mask breathing machine non-invasive ventilation. The status of mechanical ventilation, levels of blood gas indexes and lactate after treatment,adverse reactions were compared between the two groups. Results The mechanical ventilation time, apnea time after extubation and cyanosis time after extubation in the observation group were significantly shorter than those in the control group（P〈0.05）. Compared with the control group, there were higher pH and PO2, lower PCO2 and level of lactate in the observation group（P〈0.05）. The incidence of respiratory dryness in the observation group was lower than that in the control group（P〈0.05）; but there were no significant differences in the incidences of bloating, gastric retention and regurgitation between the two groups（P〈0.05）. Conclusion Nasal intermittent positive pressure ventilation can significantly reverse hypoxia and carbon dioxide accumulation of extremely low birth weight infants, which facilitates successful withdrawal of invasive ventilators without increasing adverse reactions.