呼吸支持技术治疗晚期早产儿呼吸衰竭的临床观察

发布时间：2018-06-22 06:58

本文选题：呼吸支持 + 晚期早产儿　；参考：《青岛大学》2012年硕士论文

【摘要】：目的了解呼吸支持技术治疗晚期早产儿低氧性呼吸衰竭的临床特点、疗效及并发症。方法对低氧性呼吸衰竭晚期早产儿选择性使用持续呼吸道正压通气(CPAP)、常频机械通气(CMV)、高频机械通气(HFV)三种呼吸支持技术,实施肺保护性通气策略。在治疗前、治疗后6h、12h、24h、48h、72h行血气分析,记录通气模式及呼吸机参数变化,生后4-7天行头颅心脏B超,观察颅内出血、脑室周围白质软化的发生率。结果呼吸支持治疗晚期早产儿共88例,其中新生儿呼吸窘迫综合征(NRDS)43例(48.7%),23例(27.3%)应用PS治疗。34周、35周和36周患儿通气持续时间分别为(87.80±46.34)h,(79.75±33.02)h和(60.75±23.25)h,比较差异有统计学意义(F=4.951,P=0.010)。经两两比较差异均有统计学意义(P分别为0.018,0.010和0.002)；F1020.6时间分别为(13.70±18.99)h,(7.76±13.94)h和(2.10-4.61)h,各组差异有统计学意义(F=2.957,P=0.048)。经两两比较差异均有统计学意义(P分别为0.013,0.018,0.031)。CPAP治疗者54例(61.6%),其中17例(31.4%)CPAP治疗失败后转为CMV；常频通气模式52例,其中9例转为HFV；高频机械通气(HFV)12例,通气持续时间分别为(50.58±16.78)h,(88.57±39.0])h和(103.10±35.14)h。CPAP应用时间短于CMV和HFV。呼吸支持治疗6h后FiO2、PaO2、 PaO2/FiO2、PaCO2、A-aDO2和a/A值均明显改善,分别为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,在治疗后12h、24h、48h、72h进一步改善,并维持相对的稳定。各时间点与治疗前相比差异均有统计学意义。死亡二12例(13.6%)。CMV组和HFV组在肺炎、头颅B超异常、PDA差异无统计学意义(P0.05),HFV组无气胸发生,CMV组气胸4例。结论胎龄越小,需要高浓度吸氧及辅助通气时间越长,不同通气模式治疗后血气及氧合参数均可显著改善,并发症发生率无差异。呼吸支持治疗的晚期早产儿死亡率较高。目的探讨机械通气晚期早产儿因呼吸衰竭死亡的危险因素,为早期预测其预后提供依据。方法收集2010年01月～2011年09月入住我院NICU,胎龄在34～36周早产儿88例。纳入标准：胎龄为满34周但不足37周；发生呼吸衰竭需要呼吸支持治疗；预计呼吸支持时间24h。剔除标准：有先天肺发育畸形；存在有一项或多项考虑有生命危险的先天性异常。于机械通气前及机械通气后6h、12h、24h行血气分析,记录呼吸机参数变化及预后。将其分为死亡组和存活组。结果死亡12例(13.6%)。死亡组出生体重中位数为1975g,存活组为2500g,两组差异有统计学意义。死亡组胎龄中位数为34周,产前应用激素(完全)2例(16.7%),应用PS2例(16.7%),均较存活组低,但两组比较差异均无统计学意义(Z=0.379,P=0.773)。死亡组中F10260%时间中位数为30h, PaO2、a/ADO2、PaO2/FiO2的最小值中位数分别为39.5mmHg、0.12和83.03mmHg。最高Fi02中位数为80%。最高A-aD02中位数为320mmHg,与存活组相比差异均有统计学意义。进一步对这些明显相关的变量行logistic回归分析,其独立危险因素为出生体重及最高A-aD02。回归系数分别为-0.004和-0.013,OR值分别为0.996和1.013。对A-aDO2进行ROC分析,ROC曲线下面积(AUC)为0.787,与0.5相比差异有统计学意义(P=0.002)。分界点A-aDO2=350mmHg对应的正确预测指数最大(Youden旨数=0.532)。结论机械通气晚期早产儿死亡的独立危险因素为出生体重和最高A-aDO2。 A-aDO2=350mmHg预测准确性最佳。
[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.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.6

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