容量目标通气治疗早产儿呼吸窘迫综合征的疗效

Effect of volume target ventilation in treatment of premature infant respiratory distress syndrome

目的观察容量目标通气(VTV)治疗早产儿呼吸窘迫综合征(RDS)的疗效。方法将2013年6月至2015年6月86例符合病例纳入标准的早产儿RDS患儿随机分为两组,各43例:VTV组采用同步间歇指令通气(SIMV)+压力调节(PSV)+目标容量控制通气(TTV)模式,压力控制通气组(PCV)采用SIMV+PSV模式,两组间性别比、出生胎龄与体重、使用固尔苏的剂量比较均无差别(P>0.05)。试验开始后6、24、48 h检查桡动脉血气分析,观察有创通气时间、氧疗时间、死亡率以及低碳酸血症、气胸、呼吸机相关性肺炎(VAP)、Ⅲ~Ⅳ级脑室周围-脑室内出血(PVH-IVH)、脑室周围白质软化(PVL)、支气管肺发育不良(BPD)、早产婴儿视网膜病变(ROP)的发生率。结果两组没有退出病例。VTV组有创通气时间[(72.63±12.14)h]较PCV组[(97.14±13.66)h]短(P<0.05);VTV组3次检查低碳酸血症的发生率分别为9.30%、11.63%、13.95%,PCV组分别为48.84%、58.14%、55.81%,分别比较两组3次血气分析中低碳酸血症的发生率,差别均有统计学意义(P<0.05);VTV组VAP、脑室周围白质软化的发生率(4.65%、2.33%)均低于PCV组(23.26%、18.60%)(P<0.05);VTV组吸氧时间为(168.65±39.12)h,PCV组为(167.87±38.95)h,差别无统计学意义(P>0.05);VTV组死亡率、气胸和Ⅲ~Ⅳ级PVH-IVH以及支气管肺发育不良、早产婴儿视网膜病变的发生率分别为:0、0、0、2.33%、2.33%,PCV组分别为:2.33%、0、2.33%、2.33%、4.65%,上述指标的比较差别均无统计学意义(P>0.05)。结论 VTV治疗早产儿RDS的疗效优于PCV,值得临床推广应用。

Objective To explore the effect of volume target ventilation(VTV) in treatment of premature infant respiratory distress syndrome(RDS). Methods 86 conforming cases of premature infant RDS hospitalized from June 2013 to June 2015 were randomly divided into 2 groups: 43 cases in VTV group were treated by SIMV and PSV and TTV, 43 cases in pressure control ventilation(PCV) group were treated by SIMV and PSV. There were no significant differences between the two groups in terms of gender, gestational age, birth weights, and doses of Poractant Alfa Injection(P>0.05). Blood gas analysis by artery blood was done in 6 hours, 24 hours, and 48 hours after the start of trial. The time of invasive mechanical ventilation, duration of oxygen therapy, hypocapnia incidence and mortality and complications of pneumothorax, ventilator associated pneumonia(VAP), Ⅲ- Ⅳ periventricular intraventricular hemorrhage(PVH-IVH), periventricular leukomalacia(PVL), bronchopulmonary dysplasia(BPD), retinopathy of premature infants(ROP) were observed. Results No case withdrew from the test. The time of invasive mechanical ventilation in VTV group,(72.63±12.14)h, was shorter than that in PCV group,(97.14±13.66)h(P<0.05). Incidences of three times hypocapnia in VTV group were 9.30%, 11.63%, 13.95%, while those in PCV group were 48.84%, 58.14%, 55.81%, respectively, incidences of three times hypocapnia in VTV group were lower than those in PCV group(P<0.05). Incidences of VAP and PVL in VTV group(4.65%, 2.33%) were lower than those in PCV group(23.26%, 18.60%)(P<0.05). Duration of oxygen therapy in VTV group was(168.65±39.12)h, that in PCV group was(167.87±38.95)h, they were not significantly different between the two groups(P>0.05). Mortality and incidences of pneumothorax, Ⅲ-Ⅳ PVH-IVH, BPD and ROP in VTV group were 0, 0, 0, 2.33%, 2.33%, those in PCV group were 2.33%, 0, 2.33%, 2.33%, 4.65%, respectively, they were not significantly different between the two groups(P>0.05). Conclusions The effect of VTV in treatment of premature infant RDS is better than that by PCV. VTV is a better choice to treat premature infant RDS.