容量目标通气治疗新生儿呼吸窘迫综合征的疗效

Efficacy of volume-targeted ventilation for the treatment of neonatal respiratory distress syndrome

摘要:

目的 观察容量目标通气(VTV)治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法 将2013 年8 月至2015 年8 月52 例NRDS 患儿随机分为VTV 组和压力控制通气(PCV)2 组,每组26 例。VTV组采用A/C+Vc⁺ 模式,PCV 组采用A/C+PCV 模式。试验开始后6、24、48 h 检查动脉血气分析,观察有创通气时间、氧疗时间、病死率以及低碳酸血症、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)、早产儿视网膜病变(ROP)的发生率。结果 VTV 组有创通气时间较PCV 组短(P<0.05),低碳酸血症、VAP、PVL 的发生率均低于PCV 组(P<0.05),而两组吸氧时间、病死率、气胸和Ⅲ ~ Ⅳ级PVH-IVH 以及BPD、ROP 的发生率差异无统计学意义。结论 VTV 治疗NRDS 的疗效优于PCV,值得临床推广应用。

Abstract:

Objective To investigate the efficacy of volume-targeted ventilation (VTV) for the treatment of neonatal respiratory distress syndrome (NRDS). Methods Fifty-two neonates with NRDS between August 2013 and August 2015 were randomly divided into two groups: VTV and pressure-controlled ventilation (PCV) (n=26 each ). A/C+Vc⁺ ventilation model was applied in the VTV group, and A/C+PCV ventilation model was applied in the PCV group. Arterial blood gas analysis was performed at 6, 24, and 48 hours after ventilation. The following parameters were observed: time of invasive ventilation, duration of oxygen therapy, mortality, and the incidence rates of hypocapnia, pneumothorax, ventilator-associated pneumonia (VAP), grade III-IV periventricular-intraventricular hemorrhage (PVHIVH), periventricular leukomalacia (PVL), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). Results Compared with the PCV group, the VTV group had a significantly shorter time of invasive ventilation (P<0.05) and significantly lower incidence rates of hypocapnia, VAP, and PVL (P<0.05); however, there were no significant differences in the duration of oxygen therapy, mortality, and incidence rates of pneumothorax, grade III-IV PVH-IVH, BPD, and ROP. Conclusions VTV has a better efficacy than PCV in the treatment of NRDS, and is worthy of clinical promotion and application.