| 摘要: |
| 目的探讨高频与常频通气对早产儿低碳酸血症的影响及其与预后的关系。方法回顾性分析2013年4月至2017年4月在我院NICU住院收治的需要插管机械通气的早产RDS患儿111例,按照机械通气方式分为常频组（n=55）、HFOV组（n=56）,对两组患儿的一般情况、上机后PaCO2的变化情况及神经系统预后进行分析。按照是否发生低碳酸血症分为低碳酸血症组（n=30）与非低碳酸血症组（n=81）,分析两组颅内出血与脑室周围白质病变的情况。结果常频与高频组上机后PaCO2随时间逐渐降低,与上机前比较HFOV组治疗8h有统计学差异（P<0.05）,常频组治疗24h有统计学差异（P<0.05）;常频组治疗24h的PaCO2与治疗48h有统计学差异（P<0.05）,HFOV组治疗24h的PaCO2与治疗48h无统计学差异（P>0.05）;HFOV组低碳酸血症发生的例数、低碳酸血症出现时间≤24h例数高于常频组差异有统计学意义（P<0.05）;HFOV组低碳酸血症平均值低于常频组,差异有统计学意义（P<0.05）。常频与高频两组颅内出血及脑室周围白质软化比较差异无统计学意义（P>0.05）。低碳酸血症组与非低碳酸血症组比较,低碳酸血症组颅内出血与脑室周围白质病变例数高于非低碳酸血症组,两组相比差异有统计学意义（P<0.05）。结论 HFOV与常频比较早期导致低碳酸血症的可能性增加,低碳酸血症可导致早产儿颅内出血与脑室周围白质病变,但HFOV与常频通气并未增加早产儿神经系统后遗症的发生率。 |
| 关键词: 高频振荡通气 常频机械通气 低碳酸血症 早产儿 预后 |
| DOI： |
| 分类号:R605.973； R589.6； R722.6 |
| 基金项目:四川省科技厅应用基础计划(编号:2015JY0136);四川省卫生和计划生育委员会科研课题(编号:17PJ274) |
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| Clinical Study of Hypocapnia and its Prognosis in Preterm Infants under High and Regular Frequency Ventilation |
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Peng Hao;Chen Ye;Chen Longying
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Suining Central Hospital
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| Abstract: |
| Objective To investigate the effect of high and regular frequency ventilation on hypocapnia in preterm infants and its relationship with prognosis. Methods A retrospective analysis of 111 premature infants with RDS who needed intubated mechanical ventilation in NICU in our hospital from April 2013 to April 2017 were performed and they were divided into normal frequency group（ n = 55） and HFOV group（ n = 56） according to the way of mechanical ventilation. The preterm infants of two groups were analyzed by the general situation,PaCO2 changes with ventilator and prognosis of the nervous system.According to whether hypocapnia occurred,they were divided into hypocapnic group（ n = 30） and non-hypocapnic group（ n =81） and the incidence of intracranial hemorrhage and periventricular leukoplakia in both groups were analyzed. Results The PaCO2 of the regular frequency group and the HFOV group decreased gradually with time and there was significant difference between the PaCO2 in HFOV group（ 8 h） and that before the ventilation; there was a significant difference（ P< 0. 05） between the PaCO2 in regular frequency group（ 24 h） and that before the ventilation. In regular frequency group the PaCO2 was significantly different（ P < 0. 05） between treatment for 24 h and 48 h,but there was no significant difference between those in HFOV-treated infants（ P> 0. 05）. The incidence of hypocapnia and hypocapnia within 24 h in the HFOV group was significantly higher than that in the regular frequency group（ P< 0. 05）. The average of hypocapnia in HFOV group was lower than that in the regular frequency group,and the difference was statistically significant（ P< 0. 05）. The frequency of intracranial hemorrhage and periventricular leukomalacia were no significant difference between the two groups（ P > 0. 05）. Compared with non-hypocapnic group,the number of intracranial hemorrhage and periventricular leukomalacia in hypocapnia group was significantly higher（ P< 0. 05）. Conclusion Hypocapnia is more likely to occur early in HFOV compared with regular frequency ventilation. Hypocapnia can cause intracranial hemorrhage and periventricular leukomalacia in preterm infants,but HFOV and regular frequency ventilation did not increase the incidence of neurological sequelae in preterm infants |
| Key words: high-frequencyoscillationventilation regularfrequencymechanicalventilation hypocapnia preterminfants prognosis |
