早产儿呼吸衰竭同步机械通气治疗的呼吸力学评价

目的　探讨同步间歇性指令通气 (SIMV )在早产儿机械通气中的临床意义。方法　 4 2例机械通气的早产儿随机分成两组 ,SIMV组 2 4例 ,间歇性指令通气 (IMV)组 18例 ,观察两组呼吸机参数、呼吸力学参数变化 ,以及并发症的发生率及镇静剂的使用次数。结果　上机 2 h后吸气峰压 (PIP)、呼气潮气量 (VTexp)、呼吸系统顺应性 (Crs)、气道阻力 (Raw) ,12 h后吸氧浓度 (Fi O2 ) SIMV组均明显优于 IMV组 ,2 4 h氧合指数(OI) SIMV组明显少于 IMV组 ;镇静剂的使用次数 SIMV组少于 IMV组 ,两组差异均有显著性 (P<0 .0 5或P<0 .0 1) ;并发症的发生率两组差异无显著性 (P均 >0 .0 5 )。结论　早产儿呼吸衰竭机械通气时使用 SIMV模式较 IMV能更快降低 Fi O2 、PIP、OI,较快改善肺功能 ,减少镇静剂和肌松剂的使用率。

Clinical study on respiratory mechanics of synchronized intermittent mandatory ventilation in premature infants with respiratory failure

Objective To evaluate the clinical significance of synchronized intermittent mandatory ventilation(SIMV) in prematures infants necessitating assistant ventilation. Methods Fortytwo premature infants were studied in whom SIMV was used in 24 and intermittent mandatory ventilation (IMV) was used in 18 . The parameters of fractional concentration of inspired oxygen(FiO 2), peak inspiratory pressure(PIP), expiratory tidal volume(V Texp ), oxygen index(OI), compliance of the respiratory system(Crs) and airway resistance(Raw) were compared. The frequency of administration of sedatives and incidence rate of complications were also compared between two groups. Results In SIMV group, PIP, V Texp , Raw and Crs were significant better after 2 hours ventilation(all P <0 05). There were significant difference in FiO 2 after 12 hours and OI at 24 hours in two groups. They were better in SIMV group. Sedatives were less used in SIMV group than IMV group( P <0 05). Conclusion In premature infants, SIMV could reduce FiO 2, PIP, OI, Raw and improve V Texp , Crs more rapidly when assistant ventilation is necessary. The sedatives are used less in patients on SIMV.