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目的:探讨气管插管机械通气和经鼻CPAP(nCPAP)对新生儿脑血流的影响及临床意义。方法:采用经颅多普勒超声诊断仪监测气管插管机械通气和nCPAP新生儿脑血流变化,并与同期健康足月儿做对照。结果:气管插管机械通气组脑血流参数在第1天和第2天与对照组比较,差异均有统计学意义(P<0.05),而nCPAP组在第1～3天与对照组比较,差异均无统计学意义(P>0.05);气管插管机械通气组在第2天脑血流异常率为20.0%(6/30),明显高于nCPAP组的3.3%(1/30)(P<0.05);机械通气60例新生儿最终经临床诊断有6例脑损伤,其中在第3天4例脑血流异常新生儿均被证实有脑损伤,第2天7例脑血流异常新生儿有5例被证实存在脑损伤。结论:气管插管呼吸机辅助通气对新生儿脑血流有明显影响,应尽量选择鼻塞式CPAP辅助通气,减少脑损伤的发生。
Objective: To investigate the effect of endotracheal intubation mechanical ventilation and nasal CPAP (nCPAP) on neonatal cerebral blood flow and its clinical significance. Methods: Transcranial Doppler echocardiography was used to monitor mechanical ventilation of tracheal intubation and nCPAP neonatal cerebral blood flow, and compared with full-term healthy full-term infants. Results: Compared with the control group, the cerebral blood flow parameters in the mechanical ventilation group of tracheal intubation group were significantly different on the 1st and 2nd days (P <0.05), while those of the nCPAP group on the 1st and 3rd days were significantly lower than those of the control group (P> 0.05). The rate of abnormal cerebral blood flow in the endotracheal intubation mechanical ventilation group was 20.0% (6/30) on day 2, which was significantly higher than 3.3% (1/30) in nCPAP group (P <0.05). Sixty newborns with mechanical ventilation were diagnosed as having brain injury by clinical diagnosis. Among them, four newborns with cerebral blood flow abnormalities were confirmed to have brain injury on the third day and seven cerebral blood flow on the second day Five cases of abnormal neonatal confirmed brain damage. CONCLUSION: Ventilation with ventilator assisted ventilation of ventilator has significant effect on neonatal cerebral blood flow. Nasal plug CPAP should be chosen to help ventilate and reduce the occurrence of brain injury.