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目的探讨不同方式预防极低出生体重儿(VLBWI)在机械通气治疗中并发慢性肺发育不良(BPD)的效果。方法71例VLBWI的胎龄(30±2)周,出生体重平均(1235.2±160.6)g。分别于机械通气治疗中应用方案Ⅰ为允许性高碳酸血症(PHC)组32例,方案Ⅱ为肺表面活性物质(PS)气管滴入组20例,方案Ⅲ为必可酮(BDP)气雾组19例。对三组呼吸机设置、血气分析结果、临床表现和治疗效果进行比较。结果方案Ⅰ呼吸机参数吸气峰压(PIP)和通气频率(VR)分别为(18.3±1.6)cmH2O和(35±5)bpm,显著低于方案Ⅱ、Ⅲ组(P<0.01);三组血气分析PaCO2、HCO3-有明显差异(P<0.01),但pH值、PaO2差异无统计学意义(P>0.05)。BPD的发生率方案Ⅰ为16%(5/32),方案Ⅱ为5%(1/20),方案Ⅲ为5%(1/19)。病死率方案Ⅰ为6%(2/32),方案Ⅱ为5%(1/20)。结论应用允许性高碳酸血症、肺表面活性物质气管滴入、必可酮气雾均可有效地预防VLBWI在机械通气治疗中并发严重支气管肺发育不良。
Objective To explore the effect of different ways to prevent VLBWI in patients with chronic lung dysplasia (BPD) during mechanical ventilation. Methods 71 cases of VLBWI gestational age (30 ± 2) weeks, average birth weight (1235.2 ± 160.6) g. Respectively, in the mechanical ventilation treatment for the application of Ⅰ program for the allowable hypercapnia (PHC) group of 32 cases, the program Ⅱ pulmonary surfactant (PS) tracheal injection group of 20 cases, the program Ⅲ is BDP gas 19 cases of fog group. The three sets of ventilator settings, blood gas analysis results, clinical performance and treatment were compared. Results The ventilator parameters PIP and VR were (18.3 ± 1.6) cmH2O and (35 ± 5) bpm, respectively, which were significantly lower than those of the control group Ⅱ and Ⅲ (P <0.01) Group PaCO2, HCO3-gas analysis were significantly different (P <0.01), but the pH value, PaO2 no significant difference (P> 0.05). The incidence of BPD was 16% (5/32) in scheme I, 5% (1/20) in scheme II and 5% (1/19) in scheme III. Case fatality rate Ⅰ was 6% (2/32), and rate II was 5% (1/20). Conclusion Permitted hypercapnia, pulmonary surfactant tracheal instillation, and beclomethasone aerosol can effectively prevent VLBWI complicated with severe bronchopulmonary dysplasia during mechanical ventilation.