PAV叠加SIMV模式治疗新生儿持续肺动脉高压12例临床观察

摘要

目的 观察比例辅助通气(PAV)叠加同步间歇指令通气(SIMV)治疗新生儿持续肺动脉高压(PPHN)的临床效果.方法选择2010年11月～2012年10月我院PPHN患儿12例,采用PAV+SIMV的叠加模式进行机械通气治疗,通气过程中,以维持患儿的动脉血氧饱和度(85%~93%)和呼气末二氧化碳分压(PaCO2,25~40 mm Hg)为目标调节呼吸机参数.观察通气后1、24、48、72、96 h的心率(HR)、平均动脉血压(MABP)、动脉血氧分压(PaO2)、氧合指数(OI)及呼吸机参数等变化.结果所有12例患儿均痊愈出院,平均通气时间为(107.8±7.9)h；平均吸氧时间为(8.7±1.8)d；平均住院时间为(24.2±7.6)d.机械通气后,患儿HR、呼吸频率(RR)明显减慢,差异有统计学意义(P < 0.05)；患儿pH值、PaCO2数值和PaO2数值均在正常范围内,各个时间点数值整体比较差异无统计学意义(P > 0.05)；患儿OI、吸入氧浓度、平均动脉血压(MABP)、呼气末压(PEEP)、弹性卸载(EU)、阻力卸载(RU)、气道峰压(PIP)的数值及SIMV设置呼吸次数,均随着时间延长逐步减小,各个时间点数值整体比较差异均有统计学意义(均P < 0.05).结论 PAV+SIMV的通气模式在治疗新生儿PPHN有一定的应用价值.%Objectives To observe the clinical effect of proportional assist ventilation (PAV) combined with synchronized intermittent mandatory ventilation (SIMV) in treating persistent pulmonary hypertension of the newborn (PPHN). Methods 12 cases of PPHN in our hospital from November 2010 to October 2012 were selected and treated by PAV combined with SIMV model. Breathing ventilator parameters were adjusted and the aim was SaO2 (85%—93%) and Pa-CO2 (25-40 mmHg). Heart rate (HR), MABP, PaO2, OI and some important parameters of breathing ventilator were observed 1, 24, 48, 72, 96 hours after the ventilation. Results All of 12 neonates with PPHN were cured and discharged, the mean duration of mechanical ventilation was (107.8±7.9) hours; mean oxygen dependence was (8.7 + 1.8) days, mean hospital stay was (24.2±7.6) days. HR and respiratory frequency (RR) after the mechanical ventilation were slower than those before the mechanical ventilation, the differences were statistically significant (P < 0.05); PH, PaCO2 and PaO2 were in the normal range at all time points, the differences were not statistically significant (P > 0.05); Oxygena-tion index(OI), fraction of inspiration oxygen, MABP, positive end-expiratory pressure (PEEP), elastic unloading (EU), resistive unloading (RU), the value of PIP and RR by SIMV were decreased quickly as time passed by and the differences were statistically significant at each time point (P < 0.05). Conclusion The PAV combined with SIMV have clinical prospect in treating PPHN.