比例辅助通气联合肺复张法治疗早产儿RDS对照观察

Controlled observation of proportional assist ventilation combined with recruitment maneuver in the treatment premature infants with RDS

目的探讨比例辅助通气联合肺复张法治疗早产儿呼吸窘迫综合征的疗效及对患儿肺功能、肺氧合功能及肺表面活性物质使用情况的影响。方法将104例呼吸窘迫综合征早产儿按治疗方式分为对照组(51例)及研究组(53例)。对照组予以比例辅助通气治疗,研究组予以比例辅助通气联合肺复张法治疗。比较两组疗效、临床相关指标(插管呼吸支持时间、总呼吸支持时间、肺表面活性物质使用次数、首次肺表面活性物质使用剂量、支气管肺发育不良发生率),治疗前后血气分析指标(动脉血氧分压、动脉血二氧化碳分压、pH值)、肺氧合功能(氧合指数、吸入氧浓度)、血流动力学(心输出量、每搏输出量)差异,纠正胎龄44周末肺功能(达峰时间比、达峰容积比)。结果研究组总有效率显著高于对照组(P<0.05)。治疗后两组动脉血氧分压、pH值均较治疗前显著升高(P<0.01),研究组显著高于对照组(P<0.01),两组动脉血二氧化碳分压及肺氧合功能(氧合指数、吸入氧浓度)较治疗前显著降低(P<0.01),研究组显著低于对照组(P<0.01)。治疗前后两组心输出量、每搏输出量无显著变化(P>0.05),组间比较差异无统计学意义(P>0.05)。两组均未发生气漏,研究组插管呼吸支持时间、总呼吸支持时间显著短于对照组(P<0.01),肺表面活性物质使用次数显著少于对照组(P<0.01),支气管肺发育不良发生率显著低于对照组(P<0.05)。纠正胎龄44周末研究组达峰时间比、达峰容积比均显著高于对照组(P<0.01)。结论比例辅助通气联合肺复张法治疗早产儿呼吸窘迫综合征疗效显著,能有效改善肺氧合功能及肺功能,纠正血气分析紊乱,减少肺表面活性物质使用次数,降低支气管肺发育不良发生率,有利于疾病积极转归。

Objective To investigate the effect of proportional assist ventilation(PAV)combined with recruitment maneuver in the treatment premature infants with respiratory distress syndrome(RDS)and its influence on lung function,lung oxygenation function and pulmonary surfactant(PS)use.Methods A total of 104 RDS premature infants were divided into a control group(51 cases)and a study group(53 cases)according to the treatment method.The control group received PAV therapy,and the study group received PAV combined with recruitment maneuver.The efficacy,clinical related indexes(intubation respiratory support time,total respiratory support time,frequency of PS use,dose of first PS use,incidence rates of bronchopulmonary dysplasia),blood gas analysis indexes[arterial partial pressure of blood oxygen(PaO_(2)),arterial partial pressure of blood carbon dioxide(PaCO_(2)),pH],pulmonary oxygenation function[oxygenation index(OI),fraction of inspired oxygen(FiO_(2))],hemodynamics[cardiac output(CO),stroke volume(SV)]and pulmonary function at 44 weeks of correction of gestational age[peak time ratio(TPTEF/TE),peak volume ratio(VPEF/VE)]were compared in the two groups before and after treatment.Results The total effective rate in study group was significantly higher than that in control group(P<0.05).After treatment,the values of PaO_(2) and pH in the two groups were increased compared with those before treatment(P<0.01),and those in the study group were significantly higher than those in the control group(P<0.01).The PaCO_(2) and pulmonary oxygenation(OI and FiO_(2))were significantly decreased compared with those before treatment(P<0.01),and those in the study group were significantly lower than those in the control group(P<0.01).There were no significant differences in CO and SV before and after treatment between the two groups(P>0.05).No air leakage occurred in either group,and the intubation respiratory support time,total respiratory support time were significantly shorter than those in the control group(P<0.01).Frequency of PS use was significantly lower than that in the control group(P<0.01),and the incidence rate of bronchopulmonary dysplasia was significantly lower than that in the control group(P<0.05).At 44 weeks of correction of gestational age,the pulmonary function indexes(TPTEF/TE,VPEF/VE)in the study group were higher than those in the control group(P<0.01).Conclusions PAV combined with recruitment maneuver has significant effects in the treatment of premature infants with RDS.It can effectively improve the pulmonary oxygenation,pulmonary function,and blood gas analysis indexes,and reduce the frequency of PS use,reduce the incidence of bronchopulmonary dysplasia,and is conducive to the positive outcome of the disease.