新生儿急性呼吸衰竭机械通气下肺力学的动态监测及临床意义

目的 探讨因急性呼吸衰竭而行机械通气新生儿呼吸系统力学特征，评价呼吸力学监测的临床意义。方法 利用Bicore CP-100婴儿型呼吸力学监护仪对进入新生儿重症监护病房（neonatal intensive care unit，NICU）的36例急性呼吸衰竭患儿的呼吸力学动态监测，同时监测动脉血气。结果 肺源性呼吸衰竭与呼吸泵性呼吸衰竭患儿呼吸力学参数两组上机时，差异有显著意义：Rrs（t=2．47，P＜0．05），Crs（t=2．78，P＜0．01），WOBp（t=11．03，P＜0．01），OI（t=18．26，P＜0．01）；OI与Crs有明显相关性（r=-0．93），有直线回归关系（Y=34．09-42．61X，P＜0．01）；死亡组与存活组上机时，呼吸力学参数差异有显著意义（P＜0．05）。结论 呼吸衰竭患儿机械通气下呼吸力学监测，可以反映新生儿肺部病情的动态变化，指导呼吸机治疗，判断预后，尤其对肺源性呼吸衰竭患儿有重要的实用价值，对区分肺源性呼吸衰竭与呼吸泵衰竭有着重要的参考意义。

To monitor the characteristics of respiratory mechanics in newborns with acute respiratory failure and to assess its clinical significance

Objectives To explore the characteristics of respiratory mechanics in newborns with acute respiratory failure (ARF) during tracheal intubation. To assess the significance of respiratory mechanics monitoring. Methods The indices of respiratory mechanics were measured by Bicore CP-100 pulmonary monitor in 36 newborns admitted with the NICU due to acute respiratory failure during tracheal intubation. Their arterial blood gas were examined at the same time. Results There were significant differences between pulmonary failure and respiratory pump failure in Rrs (t=2.47,P<0.05),Crs(t=2.78,P<0.01),WOBp(t=11.03,P<0.01),OI (t=18.26,P<0.01). There was negative correlation and linear regression relation between Crs and OI (r=0.93, Y=34.09-42.61X,P<0.05). There were significant difference in indices of respiratory mechanics between non-survivors and survivors (P<0.05). Conclusion Respiratory mechanics monitoring during tracheal intubation in acute respiratory failure patients is valuable in evaluating the dynamic changes of lung's disease, directing the mechanical ventilation management and predicting outcome, especially in the pulmonary failure patients. It is of importance to distinguish pulmonary failure from respiratory pump failure.