本文選題：呼吸支持 + 晚期早產(chǎn)兒��； 參考：《青島大學(xué)》2012年碩士論文

【摘要】：目的了解呼吸支持技術(shù)治療晚期早產(chǎn)兒低氧性呼吸衰竭的臨床特點(diǎn)、療效及并發(fā)癥。 方法對(duì)低氧性呼吸衰竭晚期早產(chǎn)兒選擇性使用持續(xù)呼吸道正壓通氣(CPAP)、常頻機(jī)械通氣(CMV)、高頻機(jī)械通氣(HFV)三種呼吸支持技術(shù),實(shí)施肺保護(hù)性通氣策略。在治療前、治療后6h、12h、24h、48h、72h行血?dú)夥治?記錄通氣模式及呼吸機(jī)參數(shù)變化,生后4-7天行頭顱心臟B超,觀察顱內(nèi)出血、腦室周圍白質(zhì)軟化的發(fā)生率。 結(jié)果呼吸支持治療晚期早產(chǎn)兒共88例,其中新生兒呼吸窘迫綜合征(NRDS)43例(48.7%),23例(27.3%)應(yīng)用PS治療。34周、35周和36周患兒通氣持續(xù)時(shí)間分別為(87.80±46.34)h,(79.75±33.02)h和(60.75±23.25)h,比較差異有統(tǒng)計(jì)學(xué)意義(F=4.951,P=0.010)。經(jīng)兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P分別為0.018,0.010和0.002)；F1020.6時(shí)間分別為(13.70±18.99)h,(7.76±13.94)h和(2.10-4.61)h,各組差異有統(tǒng)計(jì)學(xué)意義(F=2.957,P=0.048)。經(jīng)兩兩比較差異均有統(tǒng)計(jì)學(xué)意義(P分別為0.013,0.018,0.031)。CPAP治療者54例(61.6%),其中17例(31.4%)CPAP治療失敗后轉(zhuǎn)為CMV；常頻通氣模式52例,其中9例轉(zhuǎn)為HFV；高頻機(jī)械通氣(HFV)12例,通氣持續(xù)時(shí)間分別為(50.58±16.78)h,(88.57±39.0])h和(103.10±35.14)h。CPAP應(yīng)用時(shí)間短于CMV和HFV。呼吸支持治療6h后FiO2、PaO2、 PaO2/FiO2、PaCO2、A-aDO2和a/A值均明顯改善,分別為0.41±0.12、(85.14±25.45)mmHg、231.21±87.22、(41.95±10.45)mmHg、(119.49±75.67) mmHg和0.39±0.14,在治療后12h、24h、48h、72h進(jìn)一步改善,并維持相對(duì)的穩(wěn)定。各時(shí)間點(diǎn)與治療前相比差異均有統(tǒng)計(jì)學(xué)意義。死亡二12例(13.6%)。CMV組和HFV組在肺炎、頭顱B超異常、PDA差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),HFV組無(wú)氣胸發(fā)生,CMV組氣胸4例。結(jié)論胎齡越小,需要高濃度吸氧及輔助通氣時(shí)間越長(zhǎng),不同通氣模式治療后血?dú)饧把鹾蠀?shù)均可顯著改善,并發(fā)癥發(fā)生率無(wú)差異。呼吸支持治療的晚期早產(chǎn)兒死亡率較高。 目的探討機(jī)械通氣晚期早產(chǎn)兒因呼吸衰竭死亡的危險(xiǎn)因素,為早期預(yù)測(cè)其預(yù)后提供依據(jù)。 方法收集2010年01月～2011年09月入住我院NICU,胎齡在34～36周早產(chǎn)兒88例。納入標(biāo)準(zhǔn)：胎齡為滿34周但不足37周；發(fā)生呼吸衰竭需要呼吸支持治療；預(yù)計(jì)呼吸支持時(shí)間24h。剔除標(biāo)準(zhǔn)：有先天肺發(fā)育畸形；存在有一項(xiàng)或多項(xiàng)考慮有生命危險(xiǎn)的先天性異常。于機(jī)械通氣前及機(jī)械通氣后6h、12h、24h行血?dú)夥治?記錄呼吸機(jī)參數(shù)變化及預(yù)后。將其分為死亡組和存活組。 結(jié)果死亡12例(13.6%)。死亡組出生體重中位數(shù)為1975g,存活組為2500g,兩組差異有統(tǒng)計(jì)學(xué)意義。死亡組胎齡中位數(shù)為34周,產(chǎn)前應(yīng)用激素(完全)2例(16.7%),應(yīng)用PS2例(16.7%),均較存活組低,但兩組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(Z=0.379,P=0.773)。死亡組中F10260%時(shí)間中位數(shù)為30h, PaO2、a/ADO2、PaO2/FiO2的最小值中位數(shù)分別為39.5mmHg、0.12和83.03mmHg。最高Fi02中位數(shù)為80%。最高A-aD02中位數(shù)為320mmHg,與存活組相比差異均有統(tǒng)計(jì)學(xué)意義。進(jìn)一步對(duì)這些明顯相關(guān)的變量行l(wèi)ogistic回歸分析,其獨(dú)立危險(xiǎn)因素為出生體重及最高A-aD02�；貧w系數(shù)分別為-0.004和-0.013,OR值分別為0.996和1.013。對(duì)A-aDO2進(jìn)行ROC分析,ROC曲線下面積(AUC)為0.787,與0.5相比差異有統(tǒng)計(jì)學(xué)意義(P=0.002)。分界點(diǎn)A-aDO2=350mmHg對(duì)應(yīng)的正確預(yù)測(cè)指數(shù)最大(Youden旨數(shù)=0.532)。 結(jié)論機(jī)械通氣晚期早產(chǎn)兒死亡的獨(dú)立危險(xiǎn)因素為出生體重和最高A-aDO2。 A-aDO2=350mmHg預(yù)測(cè)準(zhǔn)確性最佳。
[Abstract]:Objective to investigate the clinical characteristics, efficacy and complications of respiratory support technology in the treatment of late premature infants with hypoxic respiratory failure.
Methods selective use of continuous positive respiratory pressure ventilation (CPAP), constant frequency mechanical ventilation (CMV), and high frequency mechanical ventilation (HFV) three respiratory support techniques were used to carry out pulmonary protective ventilation strategy. Before treatment, blood gas analysis was performed on 6h, 12h, 24h, 48h, 72h, and changes of ventilation mode and ventilator parameters were recorded, and the changes of ventilator parameters were recorded. On the 4-7 day after operation, the head and heart were examined by B-mode ultrasound to observe the incidence of intracranial hemorrhage and periventricular white matter softening.
Results there were 88 cases of advanced preterm infants with respiratory support, including 43 cases (48.7%) of neonatal respiratory distress syndrome (NRDS), 23 cases (27.3%) using PS for.34 weeks, 35 weeks and 36 weeks, respectively (87.80 + 46.34) h, (79.75 + 33.02) H and (60.75 + 23.25) h, the difference was statistically significant (P=0.010). The differences were statistically significant (P was 0.018,0.010 and 0.002 respectively); F1020.6 time was (13.70 + 18.99) h, (7.76 + 13.94) H and (2.10-4.61) h, and there were statistically significant differences in each group (F=2.957, P=0.048). 54 cases (61.6%) were statistically significant (P respectively 0.013,0.018,0.031), 17 cases (31.4%) were treated in 17 (31.4%). 52 cases of normal frequency ventilation were converted to CMV, of which 9 cases were converted to HFV, 12 cases of high frequency mechanical ventilation (HFV), the duration of ventilation was (50.58 + 16.78) h, (88.57 + 39.0]) H and (103.10 + 35.14) h.CPAP application time shorter than CMV and HFV. breathing support for 6h FiO2. It was 0.41 + 0.12, (85.14 + 25.45) mmHg, 231.21 + 87.22, (41.95 + 10.45) mmHg, (119.49 + 75.67) mmHg and 0.39 + 0.14. After treatment, 12h, 24h, 48h, 72h were further improved and maintained relative stability. The differences were statistically significant compared with those before treatment. Death two in.CMV and HFV groups were in pneumonia, abnormal head B ultrasound, PDA difference was not Statistical significance (P0.05), group HFV did not have pneumothorax, group CMV pneumothorax 4 cases. Conclusion the smaller the gestational age, the need for high concentration of oxygen inhalation and the longer auxiliary ventilation time, different ventilation modes after the treatment of blood gas and oxygenation parameters can be significantly improved, there is no difference in the incidence of complications. Respiratory support treatment of advanced premature infant mortality is higher.
Objective to explore the risk factors of death due to respiratory failure in late preterm infants with mechanical ventilation, and to provide evidence for early prognosis.
Methods 01 months from 01 months to 09 months from 2010 to 09 months in our hospital, 88 cases of preterm infants aged 34~36 weeks in 34~36 weeks were included, including 34 weeks of fetal age but less than 37 weeks; respiratory failure required respiratory support treatment; respiratory support time 24h. culling standard: congenital pulmonary malformation; there was one or more consideration of life risk. The blood gas analysis of 6h, 12h, 24h after mechanical ventilation and mechanical ventilation was performed before and after mechanical ventilation. The changes of ventilator parameters and prognosis were recorded and divided into the death group and the survival group.
The results were 12 cases (13.6%). The median of birth weight in the death group was 1975g, the survival group was 2500g, and the two groups were statistically significant. The median of the gestational age in the death group was 34 weeks, the prenatal application hormone (complete) 2 cases (16.7%) and the PS2 cases (16.7%) were lower than those in the survival group, but there was no statistical difference between the two groups (Z=0.379, P=0.773). F102 in the death group. The median of the median of 60% time was 30h, PaO2, a/ADO2, and PaO2/FiO2, the median of the minimum value was 39.5mmHg, the median of the highest Fi02 in the 0.12 and 83.03mmHg. was 80%., and the median of the highest A-aD02 was 320mmHg, and the difference was statistically significant compared with the survival group. The birth weight and the highest A-aD02. regression coefficients were -0.004 and -0.013 respectively. The OR values were 0.996 and 1.013. to A-aDO2 respectively. The area under ROC curve (AUC) was 0.787, and the difference was statistically significant (P=0.002) compared with 0.5.
Conclusion the independent risk factors for death in premature infants with advanced mechanical ventilation are birth weight and highest A-aDO2. A-aDO2=350mmHg.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R722.6

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