肺保护性机械通气和传统机械通气治疗新生儿急性呼吸衰竭临床观察

目的观察传统机械通气和肺保护性机械通气治疗新生儿急性呼吸衰竭的临床情况。方法选择40例急性呼吸衰竭新生儿患儿，随机分为两组，A组用传统机械通气，B组用肺保护性机械通气。A组潮气量（VT）10～12ml／kg，气道峰压（PIP）〈25cmH2O，呼气末正气（PEEP）（5．0±1．5）cmH2O，呼吸频率（RR）60次／min；B组VT为5～8ml／kg，PEEP为（7．6±1．5）cmH2O，RR为40～60次／分。结果转归比较：两组所有病人均治愈。呼吸机参数比较：两组在维持SaO2在90％以上且PaCO2〈8．0kPa的呼吸机各项参数，A组的VT（10．11±1．20）ml／kg、PIP（24．01±2．10）cmH2O、PEEP（7．50±1．50）cmH2O，两组VT、PIP差异有非常显著性（P〈0．01），两组PEEP的差异无显著性（P〉0．05）。血气比较：pH值A组7．35±0．10，B组7．25±0．15；PaCO2为A组（6．90±0．72）kPa，B组（93．0±2.8）kPa；两组pH、PaCO2、SaCO2（％）值比较差异均无显著性（P均〉0．05）。两组并发症比较：A组肺损伤4例，循环系统并发症3例，B组无。结论传统策略和肺保护性策略通气均能治愈新生儿急性呼吸衰竭，但后者并发症较少。在维持PH、PaCO2、PaO2、SaO2基本相同的情况下，肺保护性通气的呼吸机参数VT和PIP较传统通气明显降低。

Clinical observation on treating newborn infants of acute respiratory failure with lung protective mechanical ventilation and tradional mechanical ventilation

Objective To make observation on treating newborn infants of acute respiratory failure with lung protective mechanical ventilation and tradional mechanical ventilation. Methods 40 newborn infants of acute respiratory failure were randomly divided into two groups A and B , tradional mechanical ventilation was applied in group A and lung protective mechanical ventilation in group B . In group A ： tidal volume （VT）10 - 12ml/kg, peak intratracheal pressure （PIP）〈 25 cmH2O, positive end expiratory pressure （PEEP）（5.0±1.5 ）cmH2O, respiratory rate （RR）60/min; in group B： VT 5 - 8ml/kg, PEEP （7.6 ± 1.5）cmH2O, RR 40 - 60/m. Results All the patients in both group were cured . The parameter of breathing machine of the two groups when SaO2 was above 90 % and PaCO2 〈 80kPa： VT in group A （ 0.11 ± 1.20 ） ml/kg, PIP（24.01 ± 2.10 ） cmH2O, PEEP（7.50 ± 1.50 ） cmH2O, there was significant difference between the two groups in VT and PIP （ P 〈 0.01 ）, there difference of PEEP between the two groups was not significant （ P 〉 0. 05）. Trh comparison of blood gas ： pH value in group A was （7.35 ± 0.10） ,in group B was （7.25 ± 0.15） ;PaCO2 was （6.90 ± 0.72）kPa in goup A and （93.0 ± 2.8） kPa in group B; there was not significant difference in pH, PaCO2, SACO2 （ % ） between g group A and B （ P 〉 0.05）. For complications ： there was 4 cases of lung injury and 3 cases with complications in circulation system in group A and there was no complication in group B . Conclusion Both tradional mechanical ventilation and lung protective mechanical ventilation can cure newborn infants of acute respiratory failure but the latter has less complications ; under the circumanstance that the PH, PaCO2, PaO2, SaO2 were maintained at basically the same level , the parameters of VT and PIP in lung protective mechanical ventilation were significantly lower in those in tradional mechanical ventilation.