允许性高碳酸血症通气治疗新生儿急性呼吸衰竭疗效观察

Clinical application of permissive hypercapnia ventilation to neonatal acute respiratory failure

目的 探讨允许性高碳酸血症通气(PHV)治疗新生儿急性呼吸衰竭的疗效。方法 14例呼吸衰竭新生儿采用辅助/控制或容量控制模式,并采用PHV通气策略(PaCO_2<10.6 kPa,PH>7.15)。其参数设定为潮气量(VT)6～8 ml/kg,呼吸频率(RR)20～30次/min,气道峰压(PIP)<3.43 kPa,吸入氧浓度(FiO_2)由0.8逐渐降至0.3,吸/呼比(I:E)为1:1.5～2.0,同时监测PHV前后动脉血气(ABG)、心率(HR)、血压(BP)。结果通气前PaO_2为5.05±0.65 kPa,血pH值7.16±0.08,PaCO_2为9.55±1.22 kPa。在采用PHV模式2～6、24、72 h后,血pH值和PaO_2均明显上升(P<0.01),而PaCO_2则在72 h内保持一定范围高水平后渐下降。14例均存活,无发生气压伤及心血管系统并发症。结论 采用PHV配合充分氧疗,逐步降低PaCO_2,提高pH至正常范围,有助于防止气压伤等并发症,是抢救新生儿急性呼吸衰竭较安全、有效的机械通气方法。

Objective To investigate the effect of permissive hypercapnia ventilation(PHV) in dealing with neonatal acute respiratory failure (ARF). Methods Fourteen cases with ARF were treated by PHV,and ventilation mode was set as assistant/control or volume-control with PHV (PaCO>2<10.6 kPa,pH>7.15). Ventilation parameters were tidal volume(VT) 6~8 ml/kg,respiratory rate(RR) 20-30 breaths/min.peak inspiratory pressure(PIP)<3.43 kPa.FiO2 0.8 reduced to 0.3,1:E 1:1.5-2.0. And arterial blood gas(ABG) .heart rate(HR),blood pressure(BP) were determined before and after PHV. Results Before treatment, the mean value of PaO2 was 5.05 + 0.65 kPa,pH was 7.16 + 0.08,and PaCO2. was 9.55 + 1.22 kPa. After 2-6 hours, 24 hours.and 72 hours of PHV,and PaO2 were all raised remarkably (P<0.01). However,PaCO2 was lowered step by step above higher level in 72 hours. All cases survived without barotrauma or cardiovascular complications. Conclusions With sufficient oxygen support, PHV may gradually decrease PaCO2 and raise pH to normal levels. It is proved to be an effective mechanical ventilation therapy for neonatal ARF and barotrauma can be prevented.