双水平气道正压通气与同步间歇指令通气治疗新生儿肺出血

目的:探讨双水平气道正压通气(BIPAP)与同步间歇指令通气(SIMV)模式联合气管内滴注凝血酶治疗新生儿肺出血的疗效。方法:将63例肺出血新生儿随机分为SIMV组(30例)和BIPAP组(33例),两组均同时采用气管内滴注注射血凝酶治疗,每种模式通气12 h,稳定后分别记录两组的呼吸力学指标RR、Vte、PIP(PEEPH)、Pmean、Crs、氧动力学指标Pa CO2、Pa O2、Sa O2、Pa O2/Fi O2;并比较两组患儿最终的病死率、肺出血停止平均时间、撤离呼吸机时间、镇静剂(咪达唑仑)使用总剂量(mg)和并发症发生率。结果:两组的呼吸力学指标:RR、PIP(PEEPH)和PmeanBIPAP组低于Sl MV组(P<0.05),而Crs BIPAP组高于SIMV组(P<0.05);氧动力学指标:Pa O2和Pa O2/Fi O2BIPAP组高于SIMV组(P<0.05);病死率两组差异无统计学意义(P>0.05);肺出血停止平均时间、撤离呼吸机时间、镇静剂(咪达唑仑)使用总剂量BIPAP组均低于Sl MV组(P<0.05),BIPAP组并发症发生率高于Sl MV组(4.00%vs 31.82%,P<0.05)。结论:BIPAP通气模式人机协同性好;通过改善氧合及呼吸力学效应,有效防治肺出血,缩短病程,减少呼吸机相关并发症的发生,治疗新生儿肺出血优于SIMV。

Clinical outcomes of bi-level positive airway pressure and synchronous intermittent mandato-ry ventilation for neonates with pulmonary hemorrhage

Objective：To observe the clinical effects of endotracheal use of hemocoagulase via bi-level positive airway pressure（ BIPAP） and synchronous intermittent mandatory ventilation（SIMV） on the neonates with pulmonary hemorrhage.Methods：Sixty-three neonates with pulmonary hemorrhage were randomly allocated to group of SIMV（n=30） and BIPAP（n=33）.The two groups were managed with endotracheal drip of hemocoagulase for 12 h by ei-ther ventilation modality,and maintained regarding the indexes of respiratory mechanics （RR,Vte,PIP,Pmean,Crs） and oxygen kinetics（PaCO2,PaO2, SaO2,PaO2/FiO2） upon stable status.Still,the two groups were compared concerning the case fatality rate,average time for hemostasis,time to withdraw the ventilator,dosage of sedative required and complications.Results：The indexes of RR,PIP and Pmean in BIPAP group were lower and Crs was higher compared to the SIMV group（P＆lt;0.05）.Higher levels of PaO2 and PaO2/FiO2 were observed in the BIPAP group（P＆lt;0.05）,yet the case fatality rate remained similar between the two groups（P＆gt;0.05）.BIPAP group required less time for hemostasis and withdrawal of the ventilator as well as lower dos-age of sedative than SIMV group（P＆lt;0.05）,yet had a higher complications（4.00% vs.31.82%）（P＆lt;0.05）.Conclusion：The BIPAP mode can be su-perior to SIMV for the neonates with pulmonary hemorrhage,with its advantages of excellent patient-ventilator coordination,improvement of oxygenation and respiratory mechanics effect,effective prevention of recurrence of pulmonary hemorrhage,shortened the course of the disease and reduced the ventilator-as-sociated complications.