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目的:探讨小潮气量(LTV)加呼气末正压(PEEP)机械通气(MV)治疗新生儿低氧性呼吸衰竭(hypoxemic respiratory failure,HRF)的疗效。方法:将32例足月新生儿低氧性呼吸衰竭患儿随机分为二组,16例常规潮气量(8~12mL/kg)MV为对照组,16例小潮气量(5~8mL/kg)加用PEEP的MV模式为观察组,比较两组间患儿疾病极期呼吸机参数设置、动脉血气结果、氧合指数(PaO2/FiO2)、并发症及病死率。结果:呼吸机参数比较:观察组的吸气峰压(PIP)、平均气道压(MAP)及吸入氧浓度(FiO2)明显低于对照组,差异有显著性意义(P<0.05);动脉血气结果:两组患儿动脉氧分压(PaO2)均有明显上升(P<0.01)、两组间以观察组明显;观察组的pH值低于对照组;PaCO2高于对照组、差异有统计学意义(P<0.05);观察组的并发症及病死率明显低于对照组、差异显著有统计学意义(P<0.05)。结论:在新生儿低氧性呼吸衰竭治疗中采用小潮气量加PEEP及允许范围内高碳酸血症(PHC)的保护性通气策略,可明显改善缺氧,减少并发症发生,从而降低其病死率。
Objective: To investigate the effect of low tidal volume (LTV) and positive end expiratory pressure (PEEP) mechanical ventilation (MV) on neonatal hypoxemic respiratory failure (HRF). Methods: Thirty-two neonates with term neonatal hypoxemic respiratory failure were randomly divided into two groups: 16 patients with normal tidal volume (8-12 mL / kg) as control group, 16 patients with small tidal volume (5-8 mL / kg) MV model with PEEP was used as the observation group to compare the settings of extreme ventilator parameters, arterial blood gas results, oxygenation index (PaO2 / FiO2), complications and mortality in both groups. Results: Compared with the control group, PIP, MAP and FiO2 in the observation group were significantly lower than those in the control group (P <0.05) Blood gas results: The arterial oxygen pressure (PaO2) in both groups were significantly increased (P <0.01), the observation group between two groups was obvious; the pH value of the observation group was lower than that of the control group; PaCO2 was higher than the control group, the difference was Statistical significance (P <0.05). Complication and mortality in the observation group were significantly lower than those in the control group, the difference was statistically significant (P <0.05). CONCLUSIONS: The protective ventilation strategy of low tidal volume plus PEEP and permissive hypercapnia (PHC) in the treatment of neonatal hypoxic respiratory failure can significantly improve the hypoxia, reduce the incidence of complications and reduce its mortality .