新生儿呼吸衰竭机械通气前后酸碱失衡临床分析

目的 探讨新生儿呼吸衰竭机械通气前后酸碱失衡的类型及临床特点.方法 对81例呼吸衰竭新生儿机械通气前和机械通气12h后动脉血气进行回顾分析.结果 机械通气前检测动脉血气120次,发生酸碱失衡105次（87.5%）,其中呼吸性酸中毒（呼酸）及呼酸合并代谢性碱中毒（代碱）最常见,分别为38例次（36.2%）及28例次（26.7%）,其它依次为呼酸合并代谢性酸中毒（代酸）17例次（16%）,代酸9例次（8.57%）,呼吸性碱中毒（呼碱）并代酸6例次（5.71%）,呼酸5例次（4.76%）代碱2例次（1.90%）.单纯低氧血症6例次（5.71%）.机械通气后检测血气180例次,发生酸碱失衡104次（57.8%）,其中呼碱36例次（34.6%）最多见,其他依次为呼碱并代酸16例次（15.4%）,代碱14例次（13.5%）,呼酸并代碱12例次（11.5%）呼酸7例次（6.73%）,呼碱并代碱6例次（5.77%）,呼碱并代碱并代酸6例次（5.77%）,代酸5例次（4.81%）,呼酸合并代酸2例次（1.92%）.结论 新生儿呼吸衰竭患儿机械通气前血气以呼酸及呼酸合并代碱最多见,各种原因致通气不足和缺氧状态多引起代酸或双重酸中毒.机械通气后血气以治疗性呼碱、呼碱并代酸多见,医源性三重性酸碱平衡紊乱常被忽视.呼衰患儿合并酸碱失衡是影响呼衰转归的重要因素,在呼吸机治疗期间应定期监测血气,及时调整呼吸机参数,防止过度通气及医源性酸碱平衡紊乱的发生.

Clinical Study of Acid-Base Disturbance of Newborn with Respiratory Failure before and after Mechanical Ventilation

Objective To explore the types and clinical features of acid-base disturbance of newborn with respiratory failure before and after mechanical ventilation. Method The blood gas data before and after mechanical ventilation of 81 cases of newborn with respiratory failure were analyzed. Results 105 out of 120 cases (87.5%) showed acid-base disturbance before mechanical ventilation. The types of acid-base disturbance were respiratory acidosis (38 cases, 36.2%), respiratory acidosis combined metabolic alkalosis (28 cases, 26.7%), respiratory acidosis combined metabolic acidosis (17 cases, 16%), metabolic acidosis (9 cases, 8.57%), respiratory alkalosis combined metabolic acidosis (6 cases, 5.71%), respiratory alkalosis (5 cases, 4.76%) and metabolic alkalosis (2 cases, 1.9%). The simple low oxygenmia was 5.71%(6 cases). 104 out of 180 cases(57.8%) showed acid-base disturbance after mechanical ventilation. The types of acid-base disturbance were respiratory alkalosis(36 cases,34.6%), respiratory alkalosis combined metabolic acidosis (16 cases,15.4%), metabolic alkalosis(14 cases,13.5%), respiratory acidosis combined metabolic alkalosis(12 cases,11.5%), respiratory acidosis(7 cases,6.73%), respiratoryalkalosis combined metabolic alkalosis(6 cases, 5.77%), respiratory alkalosis combined metabolic alkalosis and metabolic acidosis (6 cases,5.77%), metabolic acidosis (5 cases,4.81%), and respiratory acidosis combined metabolic acidosis (2 cases,1.92%). Conclusions Respiratory acidosis and respiratory acidosis combined metabolic alkalosis were the most common type of acid-base disturbance before mechanical ventilation. And all kinds of low ventilation and lack of oxygen may cause metabolic acidosis or double acidosis. Respiratory alkalosis and respiratory alkalosis combined metabolic acidosis were the most common type of acid-base disturbance after mechanical ventilation, and medical tri-disturbance were usually ignored. Respiratory failure combined acid-base disturbance is an important factor in respiratory failure prognosis. Blood gas should be monitored during the treatment with respiratory machine and respiratory index should be adjusted to avoid the over-ventilation and medical acid-base disturbance.