论文部分内容阅读
目的探讨早产儿在相同呼气末正压(PEEP)水平下经鼻持续呼吸道正压(N-CPAP)模式和同步间歇正压通气(SIPPV)模式对心功能的影响。方法选择本院新生儿重症监护病房2009年3月-2011年5月收治的80例早产儿进行配对分析。其中N-CPAP治疗的20例急性呼吸窘迫综合征(RDS)患儿和SIPPV治疗的20例RDS患儿作为病例组(共40例),另外40例同期住院的一般疾病患儿按胎龄和日龄与病例组配成40对,应用彩色多普勒超声心动图检测所有患儿心脏泵血功能指标及各瓣口流速指标,比较2种通气模式对早产儿心功能指标的差异及2种不同通气方式下相同PEEP水平对早产儿心功能的影响。结果 N-CPAP组患儿肺动脉瓣口峰值流速,主动脉瓣口峰值流速,二、三尖瓣E/A值,射血分数,心排出量的均值均低于其配对组患儿,但差异均无统计学意义(Pa>0.05);SIPPV组患儿以上指标均值亦低于其配对组,其中肺动脉瓣口峰值流速,二、三尖瓣E/A值差异均有统计学意义(Pa<0.05);N-CPAP组与SIPPV组比较,SIPPV组各项心功能指标均值均低于N-CPAP组,其中对于三尖瓣E/A值的影响更明显,2组比较差异有统计学意义(0.71±0.05 vs 1.85±0.64,P<0.05)。结论 N-CPAP对早产儿心功能的影响不明显;SIPPV主要影响全心舒张功能、肺动脉及主动脉瓣峰值流速;相同PEEP水平下,SIPPV与N-CPAP相比,SIPPV主要影响早产儿的三尖瓣E/A值及右心室舒张功能。
Objective To investigate the effect of nasal continuous positive airway pressure (N-CPAP) and synchronized intermittent positive pressure ventilation (SIPPV) on cardiac function in preterm infants under the same positive end expiratory pressure (PEEP). Methods Eighty cases of premature infants who were admitted to our neonatal intensive care unit from March 2009 to May 2011 were selected for paired analysis. Among them, 20 cases of acute respiratory distress syndrome (RDS) treated with N-CPAP and 20 cases of RDS treated with SIPPV were selected as the case group (40 cases in total). Another 40 cases of common disease in hospitalized by gestational age and Day age and case group dubbed 40 pairs of color Doppler echocardiography in all children with heart pump blood function index and the velocities of each valve port flow indicators compare two kinds of ventilation patterns in preterm children with cardiac function differences and two The Effect of Different PEEP Levels on Heart Function in Premature Infants under Different Ventilation Modes. Results The mean pulmonary artery valve peak velocity, peak aortic valve velocity, tricuspid E / A, ejection fraction, and cardiac output in children with N-CPAP were lower than those in the matched group (P> 0.05). The mean values of the above indexes in SIPPV group were also lower than those in the matched group. The peak flow velocity of pulmonary valve, E / A value of tricuspid valve in two groups were all statistically significant (Pa < 0.05). Compared with SIPPV group, the mean values of cardiac function in SIPPV group were lower than those in N-CPAP group, especially for E / A value of tricuspid valve group, the difference was statistically significant (0.71 ± 0.05 vs 1.85 ± 0.64, P <0.05). CONCLUSIONS: N-CPAP has no obvious effect on heart function in preterm infants. SIPPV mainly affects diastolic function, pulmonary artery and aortic valve peak flow rate. Compared with N-CPAP, SIPPV mainly affects three Cusp E / A value and right ventricular diastolic function.