同步间歇正压通气治疗新生儿呼吸衰竭的探讨

目的探讨同步间歇正压通气较传统通气治疗新生儿呼吸衰竭的优越性及其临床应用价值。方法64例因呼吸衰竭需用机械通气治疗的新生儿，34例用同步间歇正压通气(SIPPV)，30例用间歇正压通气(IPPV)。将两组患儿的呼吸机参数氧浓度(FiO2)、吸气峰压(PIP)、呼吸频率(RR)和肺氧合功能指标在0、2、6、12、24h进行组内比较，并比较两组患儿机械通气中镇静剂的使用次数、平均上机时间以及并发症的多少。结果SIPPV组在上机后6h FiO2、PIP有显著下降(P<0.05)，RR在上机12h有显著下降。而IPPV组在上机12h FiO2开始下降、上机24h PIP才有显著下降(P<0.05)，RR在上机24h仍无显著改变。上机2h SIPPV组肺氧合功能指标较上机前明显改善，差异显著(P<0.01)，而IPPV组在上机后6h出现显著改变。SIPPV组机械通气中镇静剂的使用次数较IPPV组明显减少(P<0.05)，平均上机时间明显缩短(P<0.05)，机械通气并发症也较IPPV组明显减少(P<0.05)。结论需用机械通气的新生儿，SIPPV通气方式能更快地降低FiO2和PIP，改善通气和氧合,缩短上机时间，减少机械通气中镇静剂的使用次数和并发症的发生率。

Use of synchronized intermittent positive pressure ventilation in the treatment of neonatal respiratory failure.

AbstractObjectiveTo review the experience of using synchronized intermittent positive pressure ventilation(SIPPV) in the treatment of neonatal respiratory failure.MethodsSixty four neonates suffering from respiratory failure and requiring mechanical ventilation were divided into two groups,34 by SIPPV and 30 by intermittent positive pressure ventilation(IPPV).FiO2,PIP,respiratory rate(RR),oxygenation index,frequency of using sedative during mechanical ventilation,average time of ventilation and complications were compared between the two groups.ResultsFiO2 and PIP dropped in 6 hours and RR in 12 hours of ventilation in SIPPV group.However,FiO2 began dropping in 12 hours and PIP in 24 hours in IPPV group.RR had no obvious change in 24 hours in IPPV group.Oxygenation index was obviously improved 2 hours after use of SIPPV and 6 hours after use of IPPV.Requirement of sedative was less in SIPPV group than in IPPV group and average time of ventilation was shorter in SIPPV group than in IPPV group.The rate of complications was less in SIPPV group than in IPPV group.ConclusionSIPPV is superior to IPPV in the treatment of neonatal respiratory failure.