本文選題：透明膜病 + 嬰兒�。� 參考：《中國全科醫(yī)學(xué)》2017年29期

【摘要】：目的探討在相同通氣參數(shù)下,同步間歇正壓通氣(SIPPV)和同步間歇指令通氣(SIMV)模式對新生兒肺透明膜病(HMD)早產(chǎn)兒心功能的影響。方法選擇2013年3月—2015年3月深圳市人民醫(yī)院新生兒科收治的新生兒HMD早產(chǎn)兒100例,采用隨機數(shù)字表法分為SIPPV組50例和SIMV組50例,另外選取健康早產(chǎn)兒50例為對照組,SIPPV組與SIMV組早產(chǎn)兒均使用瑞典產(chǎn)Maquet SERVO-i呼吸機,采用合適的氣管導(dǎo)管,通氣參數(shù)相同;SIPPV組模式為SIPPV,SIMV組模式為SIMV。記錄氣道壓、潮氣量、呼吸頻率(RR)、血壓、pH值、二氧化碳分壓(PCO_2)、氧分壓(PO_2)。3組早產(chǎn)兒使用彩色多普勒超聲診斷儀測定左心室泵血功能指標(biāo),包括左心室射血分?jǐn)?shù)(LVEF)、左心室短軸縮短率(LVFS)、左心室舒張末期容積(LVEDV)、左心室收縮末期容積(LVESV)、每搏量(SV)、心率(HR)、心輸出量(CO);同時測量心臟各瓣膜血流速度,包括主動脈瓣口血流速度(AV)、肺動脈瓣口血流速度(PV)和左房室瓣口(MV)及右房室瓣口(TV)的舒張早期峰值血流速度(E峰)與舒張晚期峰值血流速度(A峰)比值(M-E/A、T-E/A)。結(jié)果 SIMV組早產(chǎn)兒氣道壓、潮氣量較SIPPV組降低(P0.05)。SIPPV組與SIMV組早產(chǎn)兒血壓、pH值、PCO_2、PO_2比較,差異均無統(tǒng)計學(xué)意義(P0.05);SIMV組早產(chǎn)兒RR較SIPPV組降低(P0.05)。3組早產(chǎn)兒LVEF、LVFS、LVEDV、LVESV、SV、CO、AV、M-E/A比較,差異均無統(tǒng)計學(xué)意義(P0.05);3組早產(chǎn)兒HR、PV、T-E/A比較,差異均有統(tǒng)計學(xué)意義(P0.05);其中SIPPV組早產(chǎn)兒HR較對照組升高,PV、T-E/A較對照組降低(P0.05);SIMV組早產(chǎn)兒HR較SIPPV組降低,PV、T-E/A較對照組降低,PV、T-E/A較SIPPV組升高(P0.05)。SIPPV組和SIMV組氣道壓、潮氣量與PV、T-E/A均呈負(fù)相關(guān)(P0.05)。結(jié)論早產(chǎn)兒應(yīng)用SIPPV和SIMV模式機械通氣,在設(shè)定相同通氣參數(shù)下,右心室舒張功能和PV降低,SIPPV模式較SIMV影響更大。兩者對左心室泵功能和舒張功能無明顯影響。
[Abstract]:Objective to investigate the effects of synchronous intermittent positive pressure ventilation (SIPPVV) and synchronous intermittent mandatory ventilation (SIMV) on cardiac function of premature infants with hyaline membrane disease (HMD). Methods from March 2013 to March 2015, 100 neonates with HMD were randomly divided into two groups: SIPPV group (n = 50) and SIMV group (n = 50). In addition, 50 healthy premature infants were selected as control group and SIMV group. All premature infants in SIMV group were given Maquet SERVO-i ventilator and suitable trachea catheter was used. The same ventilation parameters of SIPPV group was SIMV model of SIPPV-SIMV group. Airway pressure, tidal volume, respiratory frequency, blood pressure and pH value, partial pressure of carbon dioxide and PCO2C were recorded. In group PO2.3, left ventricular pump function was measured by color Doppler ultrasound. These include left ventricular ejection fraction (LVEF), left ventricular shortening rate (LVFS), left ventricular end-diastolic volume (LVEDVV), left ventricular end-systolic volume (LVESVV), SVV volume per stroke, heart rate (HRG), cardiac output (CO), and the flow velocity of each valve. The ratio of early diastolic peak flow velocity (E) to late diastolic peak flow velocity (A) of aortic valve orifice (AVV), pulmonary valvular velocity (PVV) and left atrioventricular orifice (MV) and right atrioventricular orifice (TVV) was determined. Results the airway pressure and tidal volume of premature infants in SIMV group were lower than those in SIPPV group. There was no significant difference in blood pressure and pH value between SIMV group and SIMV group. There was no significant difference in RR between SIMV group and SIMV group compared with SIPPV group. Compared with SIPPV group, the RR of premature infant in SIMV group was lower than that in SIPPV group. There was no statistical difference between the three groups of preterm infants, and there was no significant difference in T-E / A between the three groups of preterm infants. The HR of premature infants in SIPPV group was higher than that of control group, and the HR of premature infants in SIPPV group was lower than that in SIPPV group, and that in SIMV group was lower than that in SIPPV group, and that in SIPPV group was lower than that in SIPPV group, and the airway pressure in SIPPV group was higher than that in SIPPV group, and there was a negative correlation between tidal volume and PVT-EPA in SIPPV group. Conclusion SIPPV and SIMV mechanical ventilation are used in premature infants. Under the same ventilation parameters, the right ventricular diastolic function and PV decreased SIPPV are more affected than SIMV. There was no significant effect on left ventricular pump function and diastolic function.
【作者單位】： 廣東省深圳市人民醫(yī)院新生兒科;
【分類號】：R722

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