鼻塞式同步间歇指令通气在新生儿肺透明膜病撤机中的临床效果分析

摘要

Objective To evaluate the clinical effect of nasal synchronized intermittent mandatory ventilation ( nSIMV ) in the weaning of mechanical ventilation in hyaline membrane disease ( HMD ) . Methods 61 cases with HMD treated in NICU of Xuzhou Central Hospital and Suzhou Municipal Hospital from November 2009 to May 2012 were randomly divided into nSIMV group ( n = 31 ) and nCPAP group ( n = 30 ) . Results of pH value, PaCO2 , PaO2 and SpO2 as well as weaning effect were recorded and compared in two groups. Results The pH value, PaCO2 , PaO2 and SpO2 between the two groups showed no statistically significant difference before weaning ( P > 0. 05 ) . The pH value 6 h and 24 h after weaning between the two groups both showed no statistically significant difference ( P > 0. 05 ) . The PaCO2, PaO2 and SpO2 6 h and 24 h after weaning between the two groups showed no statistically significant differences ( P >0. 05 ) . The weaning failure cases [ 10% ( 3/31 ) vs. 30% ( 9/ 30 )] and apnea cases [ 19% ( 6/31 ) vs. 47% ( 14/30 ) ] between nSIMV group and nCPAP group showed statistically significant difference ( P < 0. 05 ) . The non - invasive ventilation time [ ( 69 ± 33 ) h vs. ( 75 ± 28 ) h ] between the two groups showed no statistically significant difference ( P > 0. 05 ) . Conclusion nSIMV has higher success rate compared with nCPAP when used in the weaning of mechanical ventilation, and can reduce the incidence of apnea in preterm infants.%目的 探讨鼻塞式同步间歇指令通气(nSIMV)在新生儿肺透明膜病(HMD)呼吸机撤离中的临床效果.方法 2009年11月-2012年5月徐州市中心医院和宿州市立医院新生儿重症监护病房收治61例HMD (Ⅲ～Ⅳ级)机械通气患儿,采用随机数字表法将患儿分为nSIMV组31例,鼻塞持续气道正压通气(nCPAP)组30例,观察两组撤机前后pH值、二氧化碳分压(PaCO2)、血氧分压(PaO2)、血氧饱和度(SpO2)以及撤机效果.结果 两组患儿撤机前pH值、PaCO2、PaO2、SpO2比较,差异均无统计学意义(P＞0.05).两组撤机后6 h、24 h pH值比较,差异均无统计学意义(P＞0.05);两组撤机后6 h、24 h PaCO2、PaO2、SpO2比较,差异均有统计学意义(P＜0.05).nSIMV组与nCPAP组撤机失败[10%(3/31)vs.30%(9/30)]及呼吸暂停发生率[19%(6/31)vs.47%(14/30)]比较,差异均有统计学意义(P＜0.05);两组无创通气时间[(69±33)h vs.(75±28)h]比较,差异无统计学意义(P＞0.05).结论 nSIMV用于HMD呼吸机的撤离,与nCPAP相比成功率更高,同时能减少早产儿呼吸暂停的发生.