肺保护性通气策略在足月儿低氧性呼吸衰竭治疗中的应用

Lung protective strategies of ventilation for the term neonates with hypoxemic respiratory failure

摘要:

目的：探讨肺保护性通气策略(LPSV)在足月儿低氧性呼吸衰竭(HRF)机械通气治疗中的效果。方法：53例HRF足月新生儿随机分成肺保护通气策略组(LPSV,n=27)和传统机械通气组(CMV,n=26)。对两组患儿疾病极期呼吸机参数设置、血气分析结果、呼吸机相关性肺损伤、脑室内出血、动脉导管开放发生率及病死率等进行比较分析。结果：呼吸机参数比较:LPSV组的吸气峰压(PIP)和平均气道压(MAP)分别为2.50±0.28和1.04±0.25kPa,明显低于CMV组(2.97±0.35和1.28±0.30kPa)(P<0.01);呼气末正压(PEEP)为0.61±0.08kPa,明显高于CMV组(0.53±0.09kPa)(P<0.01);两组吸入氧浓度、吸气时间和呼吸频率差异无统计学意义(P>0.05)。血气分析结果:LPSV组的pH为7.29±0.10,低于CMV组(7.38±0.12);PaCO2为7.13±1.02kPa,高于CMV组(5.40±1.06kPa),差异有统计学意义(P<0.01);两组的动脉氧分压和氧饱和度差异无显著性意义(P>0.05)。通气过程中,LPSV组的气漏发生率明显低于CMV(4%vs35%,P<0.01),两组的脑室内出血、肺出血和动脉导管开放发生率无显著差异。LPSV组的病死率为11%(3/27),显著低于CMV组[35%(9/26)]。结论：肺保护通气策略是一种HRF患儿适当的机械通气模式,可显著降低气漏发生率和病死率。

Abstract:

OBJECTIVE: To study the effect of lung protective strategies of ventilation on the term neonates with hypoxemic respiratory failure (HRF). METHODS: Fifty-three term neonates with HRF were randomly divided into two groups: lung protective ventilation (LPV) group (n=27) and conventional mechanical ventilation (CMV) group (n=26). The parameters of ventilation, results of blood-gas analysis, incidences of ventilator-associated lung injury, intraventicular hemorrhage (IVH) and patent ductus arteriosus (PDA), and mortality were compared. RESULTS: In the peak stage of HRF, peak inflation pressure (PIP) and mean airway pressure (MAP) were 2.50±0.28 and 1.04±0.25 kPa respectively in the LPV group, significantly lower than those in the CMV group (2.97±0.35 and 1.28±0.30 kPa, P<0.01). Positive end-expiratory pressure (PEEP) in the LPV group was significantly higher than that in the CMV group (0.61±0.08 kPa vs 0.53±0.09 kPa, P<0.01). There were no differences in fraction of inspired oxygen (FiO_2), inspiratory time (Ti) and ventilation rate between the two groups. The pH (7.29±0.10) in the LPV group was lower than that in the CMV group (7.38±0.12, P<0.01), but PaCO_2 (7.13±1.02 kPa) was higher than that in the CMV group (5.40±1.06 kPa, P<0.01). The PaO_2 and SaO_2 of the LPV group were not different from those of the CMV group. The LPV group showed lower incidence of air leak (4% vs 35%, P<0.01) and similar incidences of IVH, PDA and lung hemorrhage to the CMV group. LPV resulted in a decreased mortality compared with CMV (11%(3/27) vs 35%(9/26), P<0.05). CONCLUSIONS: Using lung protective strategies in mechanical ventilation can markedly reduce the incidence of air leak and mortality for neonates with HRF.