两种不同通气模式在呼吸窘迫综合征早产儿撤机阶段的应用对比

A comparative study of two ventilation modes in the weaning phase of preterm infants with respiratory distress syndrome

目的比较同步间歇指令通气(SIMV)与压力支持加容量保证通气(PSV+VG)两种模式在呼吸窘迫综合征(RDS)早产儿撤机阶段的应用效果。方法选择2016年3月至2017年5月入住新生儿重症监护室、胎龄小于32周,且需要机械通气的40例RDS早产儿作为研究对象。40例患儿从进入撤机阶段开始被随机分为SIMV组和PSV+VG组,每组各20例。比较两组间呼吸机参数、动脉血气、撤机时间(从进入撤机阶段到拔管时间)、拔管后经鼻持续气道正压通气(NCPAP)使用时间以及拔管失败率;比较两组病死率及气胸、动脉导管未闭(PDA)、支气管肺发育不良(BPD)的发生率。结果与SIMV组比较,PSV+VG组的平均气道压、撤机时间、撤机后NCPAP使用时间、拔管失败率均明显降低,差异有统计学意义(P<0.05)。而两组在动脉血气、病死率及气胸、PDA、BPD发生率等方面的比较差异均无统计学意义(P>0.05)。结论在RDS早产儿撤机阶段,PSV+VG模式可能是一种相对安全有效的通气方式,但仍需要大样本、多中心的临床试验来证实。

Objective To compare the efficacy between synchronized intermittent mandatory ventilation（SIMV） and pressure support ventilation with volume guarantee（PSV＋VG） in the weaning phase of preterm infants with respiratory distress syndrome（RDS）. Methods Forty preterm infants with RDS who were admitted to the neonatal intensive care unit between March 2016 and May 2017 were enrolled as subjects. All infants were born at less than 32 weeks＇ gestation and received mechanical ventilation. These patients were randomly and equally divided into SIMV group and PSV＋VG group in the weaning phase. Ventilator parameters, arterial blood gas, weaning duration（from onset of weaning to extubation）, duration of nasal continuous positive airway pressure（NCPAP） after extubation, extubation failure rate, the incidence rates of pneumothorax, patent ductus arteriosus（PDA） and bronchopulmonary dysplasia（BPD）, and the mortality rate were compared between the two groups. Results The PSV＋VG group had significantly decreased mean airway pressure, weaning duration, duration of NCPAP after extubation, and extubation failure rate compared with the SIMV group（P〈0.05）. There were no significant differences in arterial blood gas, mortality, or incidence rates of pneumothorax, PDA and BPD between the two groups（P〉0.05）. Conclusions For preterm infants with RDS, the PSV＋VG mode may be a relatively safe and effective mode in the weaning phase. However, multi-center clinical trials with large sample sizes are needed to confirm the conclusion.