目标容量控制通气治疗重症新生儿呼吸窘迫综合征的前瞻性随机对照研究

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摘要目的：评价目标容量控制通气治疗重症新生儿呼吸窘迫综合征（NRDS）的疗效。方法：将2008年6月至2010年1月收治的84例重症NRDS患儿随机分为3组：同步间歇正压加容量保证通气组（SIPPV+VG，31例）、高频振荡通气组（HFOV，23例）、间歇指令通气组（IMV，30例）。观察各组氧合情况、氧疗时间、呼吸机使用时间及并发症发生情况。结果：SIPPV+VG组、HFOV组患儿在上机12 h时氧合明显改善，P/F值、a/APO2与上机前比较差异有统计学意义（P<0.05），而IMV组直至24 h氧合方有改善； SIPPV+VG、HFOV组患儿氧疗时间和呼吸机使用时间均低于IMV组（P<0.05）； SIPPV+VG、HFOV组患儿气漏和呼吸机相关性肺炎（VAP）的发生率均低于IMV组（P<0.05）；HFOV组III级以上颅内出血发生比率高于SIPPV+VG和IMV组。结论：SIPPV+VG和HFOV比IMV能更迅速地改善重症NRDS患儿氧合状况，缩短氧暴露和呼吸机应用时间，减少气漏、VAP的发生。

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	刘翠青
	崔泽
	夏耀方
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	范丽莉

关键词 ：目标容量控制通气, 同步间歇正压通气, 高频振荡通气, 呼吸窘迫综合征, 新生儿

Abstract：OBJECTIVE: To evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome (RDS). Methods: Eighty-four neonates with severe RDS between June 2008 and January 2010 were randomly assigned to 3 groups according to the ventilation mode: synchronized intermittent positive pressure ventilation plus volume guarantee (SIPPV+VG; n=31), high frequency oscillation ventilation (HFOV; n=23) and intermittent mandatory ventilation (IMV; n=30). The oxygenation status, the durations of oxygen exposure and ventilation and the incidence of complications were observed. Results: The oxygenation status (P/F and a/APO2) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation (P＜0.05). While in the IMV group, the oxygenation status was not improved until 24 hrs after ventilation. The durations of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group (P<0.05). The incidences of air leak syndrome and ventilation-associated pneumonia (VAP) were lower in the SIPPV+VG and the HFOV groups than in the IMV group (P<0.05). The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups (P<0.05). Conclusions: Compared with IMV, SIPPV+VG and HFOV can improve the oxygenation status more quickly, shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS.

Key words： Targeted tidal volume ventilation Synchronized intermittent positive pressure ventilation High frequency oscillation ventilation Respiratory distress syndrome Neonate

PACS:

R722.1

引用本文:

刘翠青,崔泽,夏耀方等. 目标容量控制通气治疗重症新生儿呼吸窘迫综合征的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2011, 13(9): 696-699.

LIU Cui-Qing,CUI Ze,XIA Yao-Fang et al. Randomized controlled study of targeted tidal volume ventilation for treatment of severe neonatal respiratory distress syndrome[J]. CJCP, 2011, 13(9): 696-699.

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http://www.zgddek.com/CN/ 或 http://www.zgddek.com/CN/Y2011/V13/I9/696

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