容量保证机械通气在呼吸窘迫综合征早产儿中应用

Application of volume guaranteed ventilation in preterm infants with respiratory distress syndrome

目的 比较容量保证(VG)与压力控制(PC)两种机械通气模式在呼吸窘迫综合征(RDS)早产儿中的应用效果。方法 前瞻性选择2017年03月至2021年04月NICU收治的胎龄<32周或出生体质量<1 500g,需要有创机械通气的RDS早产儿作为研究对象,按简单随机法分为VG组和PC组。比较两组拔管前的呼吸机参数及动脉血气,有创机械通气时间、总呼吸支持时间及平均住院时间,并发症发生率及病死率。结果 最终RDS早产儿79例完成研究,男46例、女33例,平均胎龄(30.1±1.2)周,平均出生体质量(1 239.0±158.0)g,VG组36例、PC组43例。与PC组比较,VG组在拔管前的平均气道压较低,有创机械通气时间、总呼吸支持时间以及平均住院时间均缩短,差异有统计学意义(P<0.05)。结论 在RDS早产儿的机械通气治疗中,VG通气可能是一种更加安全有效的通气方式,但仍需要大样本、多中心的临床试验证实。

Objective To compare the effects of volume guaranteed (VG) ventilation and pressure controlled (PC) ventilation in premature infants with respiratory distress syndrome (RDS).Methods RDS premature infants with gestational age <32 weeks or birth weight <1500g and requiring invasive mechanical ventilation from March 2017 to April 2021 were prospectively enrolled in the study.Patients were divided into VG group and PC group by simple random method.Before extubation,ventilator parameters,arterial blood gas,invasive mechanical ventilation time,total respiratory support time,average hospital stay,incidence of complications and mortality were compared between the two groups.Results Finally,79 premature infants with RDS (46 boys and 33 girls) completed the study,the average gestational age was (30.1±1.2) weeks and the average birth weight was (1239.0±158.0) g.There were 36 patients in the VG group and 43 patients in the PC group.Compared with the PC group,the average airway pressure before extubation was lower in the VG group,and invasive mechanical ventilation time,total respiratory support time and average hospital stay were shortened,with statistically significant differences (P<0.05).Conclusions For premature infants with RDS,the VG mode may be a safer and more effective mode of mechanical ventilation.However,multi-center clinical trials with large sample sizes are needed to verify the results of our current study.