允许性高碳酸血症在早产儿呼吸窘迫综合征治疗中的应用

Application of permissive hypercapnia in premature infants with respiratory distress syndrome

目的分析允许性高碳酸血症在早产儿呼吸窘迫综合征(RDS)治疗中的效果。方法收集2019年7月至2020年9月中国医科大学附属盛京医院NICU收治的主要诊断为新生儿RDS的早产儿70例,采用LISA法注入肺表面活性物质后随机分为允许性高碳酸血症(PHC)组34例(无创高频通气+PHC)和非PHC组36例(无创高频通气),比较两组患儿呼吸机参数、呼吸机使用时间、氧疗时间、开奶日龄及住院天数。记录两组患儿动脉导管开放、颅内出血、气胸、呼吸机相关性肺损伤及支气管肺发育不良的发生率。结果PHC组患儿机械通气时间、氧疗时间、开奶日龄及住院时间均小于非PHC组(P<0.05),机械通气治疗前两组患儿PaO2及PaCO2差异无统计学意义(P>0.05),治疗24 h后两组PaO2差异无统计学意义(P>0.05),非PHC组患儿PaCO2较治疗前明显降低(P<0.05),PHC组无明显变化。两组患儿治疗24 h后呼吸机参数、MAP及FiO2比较差异无统计学意义(P>0.05),振幅PHC组明显低于非PHC组(P<0.05)。两组患儿动脉导管开放、气胸、颅内出血及支气管肺发育不良发生率差异无统计学意义(P>0.05),PHC组患儿呼吸机相关性肺损伤的发生率低于非PHC组(P<0.05)。结论PHC与常规通气疗法相比治疗效果相似,但可缩短机械通气时间、氧疗时间、开奶日龄及住院天数,可以减少呼吸机相关性肺损伤的发生,具有临床推广价值。

Objective To analyze the effect of permissive hypercapnia(PHC)in premature infants with respiratory distress syndrome(RDS).Methods Seventy preterm infants diagnosed with RDS from July 2019 to September 2020 were enrolled.The preterm infants were divided into PHC group[noninvasive high-frequency ventilation(NHFV)+PHC,n=34]and non PHC group(NHFV,n=36)after injection of pulmonary surfactant by LISA method.Ventilator parameters,time of ventilation,oxygen therapy,enteral feedingand hospitalization days were compared between the two groups.The incidences of patent ductus arteriosus,intracranial hemorrhage,pneumothorax and ventilator-induced lung injury were recorded.Results The time of mechanical ventilation,oxygen therapy,age of enteral feeding and hospitalization time in PHC group were less than those in non PHC group(P<0.05).PaO2 and PaCO2 of the two groups had no difference before mechanical ventilation treatment(P>0.05),and PaO2 of the two groups had no difference after 24 hours of treatment(P>0.05).After treatment,PaCO2 in non PHC group was significantly lower,and there was no significant difference in PHC group(P<0.05).There was no significant difference regarding ventilator parameters MAP and FiO2 after 24 hours of treatment between the two groups(P>0.05),and theΔP of PHC group was significantly lower than that of non-PHC group(P<0.05).The incidence of ventilator-induced lung injury in PHC group was lower than that in non-PHC group(P<0.05).Conclusion Compared with conventional ventilation therapy,PHC has similar therapeutic effect,but it can shorten the mechanical ventilation time,oxygen therapy time,age of enteral feeding and hospitalization days,and reduce the incidence of ventilator-induced lung injury.