同步间歇指令通气联合压力调节加目标容量控制通气治疗新生儿呼吸窘迫综合征效果观察

摘要

目的：观察同步间歇指令通气( SIMV)联合压力调节( PSV)加目标容量控制通气( TTV)治疗新生儿呼吸窘迫综合征( NRDS)的效果。方法将唐山市妇幼保健院2011年4月—2014年4月收治的53例NRDS患儿分为SIMV+PSV+TTV组( n=27例)和辅助/控制通气组( A/C组,n=26),记录两组治疗不同时间点的氧合状况、并发症发生及转归情况。结果 SIMV+PSV+TTV组在机械通气6 h时动脉血氧分压/吸入氧体积分数( P/F)和肺泡-动脉血氧分压比(a/APO2)即明显优于0 h(P<0．05),氧合改善较A/C组迅速,两组在治疗6 h后P/F和a/APO2均有显著改善趋势(P<0．05)；SIMV+PSV+TTV组P/F和a/APO2在治疗6、24、72 h时均优于A/C组(P<0．05)。 SIMV+PSV+TTV组气漏综合征和呼吸机相关性肺炎的发生率均低于A/C组( P<0．05)；两组病死率差异无统计学意义(P>0．05)。结论 SIMV+PSV+TTV模式比A/C模式能更迅速地改善NRDS患儿的氧合状况,减少氧暴露,降低高容量通气导致的并发症,是治疗NRDS的有效方法。%Objective To observe the effect of synchronized intermittent mandatory ventilation (SIMV) com-bined with pressure support ventilation ( PSV) and targeted tidal volume ( TTV) in treatment of neonatal respiratory dis-tress syndrome ( NRDS) . Methods Fifty-three NRDS neonates in Maternal and Child Health Hospital of Tangshan dur-ing April 2011 and April 2014 were randomly divided into SIMV+PSV+TTV group ( n=27 ) and assist/control group (A/C group, n=26), and the oxygenation status, complication incidence and turnover rates were recorded in the two groups at different time points. Results The score of arterial partial pressure of oxygen/inspired oxygen ( P/F) and alve-olar-arterial partial pressure of oxygen ( a/APO2 ) in the SIMV+PSV+TTV group on 6 h after ventilation were signifi-cantly improved, compared with those on 0 h (P<0. 05), and oxygenation improvement in the SIMV+PSV+TTV group was quicker, compared with that in A/C group, and the values of P/F and a/APO2 were significantly improved in the two groups on 6 h after ventilation (P<0. 05);compared with those in A/C group, the values of P/F and a/APO2 were sig-nificantly improved on 6 h, 24 h and 72 h after ventilation in the SIMV+PSV+TTV group (P<0. 05). The incidence rates of air leak syndromes and ventilator-associated pneumonia ( VAP) in the SIMV+PSV+TTV group were lower than those in the A/C group (P<0. 05). There was no significant difference in the fatality rates between the two groups (P>0. 05). Conclusion Compared with those by A/C mode, SIMV+PSV+TTV mode may improve the oxygenation status more quickly, decrease the incidence rates of air leak syndromes and VAP in NRDS neonates, and it is an effective meth-od in treatment of NRDS.