不同水平呼气末正压对新生儿急性呼吸窘迫 综合征的疗效及血流动力学的影响

Effects of different positive end-expiratory pressure therapy on acute respiratory distress syndrome and hemodynamics in neonates

摘要:

目的 探究不同水平呼气末正压（PEEP）治疗新生儿急性呼吸窘迫综合征（ARDS）的疗效及 其血流动力学影响。方法 选取2017 年3 月—2019 年5 月天津市中心妇产科医院收治的112 例ARDS 新生 儿。根据通气的不同分为研究组和对照组，研究组58 例患儿接受高水平PEEP（6 ～ <9 cm H2O）治疗，对照 组54 例患儿接受低水平PEEP（3 ～ <6 cm H2O）治疗。观察两组患者治疗前及治疗稳定后24 h 的心率（HR）、 平均肺动脉压（MPAP）、中心静脉压（CVP）、pH 值、动脉血二氧化碳分压（PaCO2）、氧合指数（OI）水平、 气道阻力（Raw）、呼吸系统顺应性（Crs）。观察两组患者的机械通气时间、住院时间、死亡例数。结果 研 究组HR、MPAP 降低的差值，以及CVP 升高的差值均高于对照组（P <0.05）；研究组pH 值、OI 升高的差 值，以及PaCO2 降低的差值均高于对照组（P <0.05）；研究组Raw 降低的差值及Crs 升高的差值均高于对照 组（P <0.05）。研究组机械通气时间、住院时间均短于对照组（P <0.05）；研究组死亡率低于对照组（P <0.05）。 结论 高水平PEEP 对新生儿血流动力学指标的改善作用更明显，对气体交换和呼吸力学的影响更大，能有 效减少机械通气时间及住院时间，降低病死率。

Abstract:

Objective To investigate the effects of positive end-expiratory pressure (PEEP) on neonatal acute respiratory distress syndrome (ARDS) and hemodynamics. Methods 112 newborn ARDS patients admitted to our hospital from March 2017 to May 2019 were selected and divided into two groups according to different ventilation conditions, among which 58 patients were treated with high PEEP (study group) and 54 patients were treated with low PEEP (control group). Meanwhile, FiO2 was adjusted according to the arterial partial pressure of oxygen (PaO2), and PaO2 was guaranteed to exceed 60mmHg. Before and after treatment, 24h heart rate (HR), mean pulmonary arterial pressure (MPAP) and central venous pressure (CVP), pH value, arterial partial pressure of carbon dioxide (PaCO2), oxygenation index (OI), airway resistance (Raw) and compliance of the respiratory system (Crs) were observed. The duration of mechanical ventilation, length of hospital stay, and proportion of deaths occurred in the two groups were analyzed. Results MPAP, pH value, OI and Crs in the two groups were increased at 24h after treatment (P < 0.05), and those of the study group was higher than those of the control group (P < 0.05). HR, MPAP, PaCO2 and Raw were lower in the two groups at 24h after treatment (P < 0.05), and the those of the study group was lower than those of the control group (P < 0.05). The increasing degree of CVP and the decreasing degree of HR value and MPAP at 24h after treatment were higher in the study group than those in the control group (P < 0.05). The duration of mechanical ventilation and hospital stay in the study group were both lower than those in the control group (P < 0.05). The mortality rate of the study group was lower than that of the control group (P < 0.05). Conclusions High PEEP better improves the hemodynamics of neonates, has a stronger effect on gas exchange and respiratory mechanics, and effectively reduces the duration of mechanical ventilation and hospitalization as well as the mortality.