同步间歇正压通气和同步间歇指令通气对新生儿肺透明膜病早产儿心功能的影响研究

发布时间：2018-06-20 08:19

本文选题：透明膜病 + 婴儿　；参考：《中国全科医学》2017年29期

【摘要】：目的探讨在相同通气参数下,同步间歇正压通气(SIPPV)和同步间歇指令通气(SIMV)模式对新生儿肺透明膜病(HMD)早产儿心功能的影响。方法选择2013年3月—2015年3月深圳市人民医院新生儿科收治的新生儿HMD早产儿100例,采用随机数字表法分为SIPPV组50例和SIMV组50例,另外选取健康早产儿50例为对照组,SIPPV组与SIMV组早产儿均使用瑞典产Maquet SERVO-i呼吸机,采用合适的气管导管,通气参数相同;SIPPV组模式为SIPPV,SIMV组模式为SIMV。记录气道压、潮气量、呼吸频率(RR)、血压、pH值、二氧化碳分压(PCO_2)、氧分压(PO_2)。3组早产儿使用彩色多普勒超声诊断仪测定左心室泵血功能指标,包括左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、每搏量(SV)、心率(HR)、心输出量(CO);同时测量心脏各瓣膜血流速度,包括主动脉瓣口血流速度(AV)、肺动脉瓣口血流速度(PV)和左房室瓣口(MV)及右房室瓣口(TV)的舒张早期峰值血流速度(E峰)与舒张晚期峰值血流速度(A峰)比值(M-E/A、T-E/A)。结果 SIMV组早产儿气道压、潮气量较SIPPV组降低(P0.05)。SIPPV组与SIMV组早产儿血压、pH值、PCO_2、PO_2比较,差异均无统计学意义(P0.05);SIMV组早产儿RR较SIPPV组降低(P0.05)。3组早产儿LVEF、LVFS、LVEDV、LVESV、SV、CO、AV、M-E/A比较,差异均无统计学意义(P0.05);3组早产儿HR、PV、T-E/A比较,差异均有统计学意义(P0.05);其中SIPPV组早产儿HR较对照组升高,PV、T-E/A较对照组降低(P0.05);SIMV组早产儿HR较SIPPV组降低,PV、T-E/A较对照组降低,PV、T-E/A较SIPPV组升高(P0.05)。SIPPV组和SIMV组气道压、潮气量与PV、T-E/A均呈负相关(P0.05)。结论早产儿应用SIPPV和SIMV模式机械通气,在设定相同通气参数下,右心室舒张功能和PV降低,SIPPV模式较SIMV影响更大。两者对左心室泵功能和舒张功能无明显影响。
[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.
【作者单位】：广东省深圳市人民医院新生儿科;
【分类号】：R722

【相似文献】