摘要
目的 分析低潮气量通气辅以允许性高碳酸血症通气治疗足月儿重症胎粪吸入综合征的临床效果。方法 将本院2013年2月至2015年10月确诊并收治的116例足月重症胎粪吸入综合征患儿按照随机数表法分为研究组和对照组,每组各58例。两组患儿均实施基础对症治疗及无创机械通气治疗。对照组患儿应用常规潮气量参数设置进行无创机械通气,研究组患儿实施呼吸机低潮气量通气并给予允许性高碳酸血症通气治疗。比较两组患儿治疗后存活情况,存活患儿治疗前后血气指标、整体治疗情况及并发症发生率。结果 研究组患儿死亡率显著低于对照组（χ^2=7.00,P〈0.05）。治疗前两组存活患儿动脉血p H、动脉血二氧化碳分压（Pa CO2）、动脉血氧分压（Pa O2）比较差异均无显著性（P〉0.05）;治疗后3天研究组患儿动脉血p H及Pa CO2显著高于对照组（P〈0.05）,Pa O2比较无显著差异（P〉0.05）;两组患儿撤机后动脉血pH、PaCO_2、PaO_2比较均无显著差异（P〉0.05）。研究组存活患儿呼吸机使用时间、吸氧时间及住院时间均显著短于对照组（P〈0.05）。两组患儿持续肺动脉高压及肺出血发生率比较差异均无显著性（P〉0.05）,研究组患儿呼吸机肺损伤发生率显著低于对照组（P〈0.05）。结论 重症胎粪吸入综合征足月儿给予低潮气量通气辅以允许性高碳酸血症通气治疗能够在保障治疗效果的同时,显著缩短疗程,且极大地规避了传统机械通气治疗引发呼吸机肺损伤的发生风险,降低患儿死亡率。
Objective To analyze the clinical effects of low tidal volume mechanical ventilation supplem-ented with permissive hypercapnic ventilation in treating term infants with severe meconium aspiration syndrome. Method 116 cases of term infants with severe meconium aspiration syndrome admitted and treated in our hospital from February 2013 to October 2015 were divided into study group and control group according to a random number table method, 58 cases in each group. The term infants in both groups were given expectant treatment combined with noninvasive mechanical ventilation treatment. Meanwhile, in control group, the ventilators were set up noninvasive mechanical ventilation by applying conventional tidal volume parameter. And in study group, the ventilators were set up low tidal volume mechanical ventilation supplemented with permissive hypercapnic ventilation. Compared the term infants survival condition, blood gas index of before and after treatment, the overall treatment condition and the complications occurrence rates. Result The mortality of study group was significantly lower than control group （χ^2 = 7.00, P 〈 0.05）. Before treatment, there were no significant differences in arterial blood pH, arterial carbon dioxide partial pressure （PaCO2） and arterial oxygen partial pressure （PaO2） between the two groups （P 〉 0.05）. 3 days after treatment, the pH and PaCO2 of study group was significantly higher than control group （P 〈 0.05）. There was no significant difference in PaO2 （P 〉 0.05）. The pH, PaCO2, and PaO2 after weaning ventilation showed no significant difference between the two groups （P 〉 0.05）. The ventilator service time, oxygen inhalation time and hospital stay length of study group were significantly shorter than control group （P 〈 0.05）. The continued pulmonary hypertension and empsyxis occurrence rate in both groups showed no significant difference （P 〉 0.05）. The ventilator lung injury occurrence rate of study group was significantly lower than control group （P 〈 0.05）. Conclusion Low tidal volume mechanical ventilation supplemented with permissive hypercapnic ventilation in treating term infants with severe meconium aspiration syndrome can ensure the therapeutic effects, significantly shorten the course of treatment, and greatly avoid the risk of ventilator lung injury caused by the traditional ventilation therapy, and greatly reduce the mortality.
出处
《中国医学前沿杂志（电子版）》
2016年第6期199-203,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
胎粪吸入综合征
足月儿
无创通气
低潮气量
允许性高碳酸血症通气
Meconium aspiration syndrome
Term infants
Noninvasive ventilation
Low tidal volume
Permissive hypercapnic ventilation
