[1]康　乐.不同通气方式对肺表面活性物质治疗的呼吸窘迫综合征早产儿脑氧代谢的影响[J].新乡医学院学报,2018,35(12):1115-1117.[doi:10.7683/xxyxyxb.2018.12.018]
　KANG Le.Effect of different ventilation modes on cerebral oxygen metabolism in preterm infants with respiratory distress syndrome treated with pulmonary surfactant[J].Journal of Xinxiang Medical University,2018,35(12):1115-1117.[doi:10.7683/xxyxyxb.2018.12.018]
点击复制

不同通气方式对肺表面活性物质治疗的呼吸窘迫综合征早产儿脑氧代谢的影响
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年12
页码:
1115-1117
栏目:
临床研究
出版日期:
2018-12-05

文章信息/Info

Title:
Effect of different ventilation modes on cerebral oxygen metabolism in preterm infants with respiratory distress syndrome treated with pulmonary surfactant
作者:
康　乐
（驻马店市中心医院新生儿科，河南　驻马店　463000）
Author(s):
KANG Le
（Department of Neonatology，Zhumadian Central Hospital，Zhumadian 463000，Henan Province，China）
关键词:
早产儿; 呼吸窘迫综合征; 手动通气; 机械通气; 脑氧代谢; 脑氧饱和度
Keywords:
premature infant; respiratory distress syndrome; manual ventilation; mechanical ventilation; cerebral oxygen metabolism; cerebral oxygen saturation
分类号:
R722.1
DOI:
10.7683/xxyxyxb.2018.12.018
文献标志码:
A
摘要:
目的　探讨不同通气方式对肺表面活性物质（PS）治疗的呼吸窘迫综合征（RDS）早产儿脑氧代谢的影响。方法　选择2015年1月至2018年1月驻马店市中心医院收治的132例RDS早产儿为研究对象，根据PS应用过程中的通气方式将患儿分为A组和B组，每组66例。A组患儿PS应用过程中给予手动气囊加压通气，B组患儿PS应用过程中给予呼吸机持续机械通气。治疗过程中使用近红外光谱仪监测患儿脑氧饱和度（SCO2），通过动脉留置导管监测平均动脉压（MAP），对2组患儿用药前5 min、用药期间和用药后5、10 min时SCO2、SCO2与MAP的相关系数（rSCO2-MAP）及并发症发生率进行比较。结果　2组早产儿给药期间和给药后5 min时SCO2显著高于给药前5 min和给药后10 min（P<0.05），2组早产儿给药后10 min与给药前5 min时SCO2比较差异无统计学意义（P>0.05），给药前5 min、给药期间及给药后5、10 min时2组早产儿SCO2比较差异均无统计学意义（P>0.05）。2组早产儿给药期间rSCO2-MAP显著高于给药前5 min和给药后10 min（P<0.05），2组早产儿给药后10 min与给药前5 min时rSCO2-MAP比较差异无统计学意义（P>0.05），给药前5 min、给药期间及给药后5、10 min时2组早产儿rSCO2-MAP比较差异均无统计学意义（P>0.05）。A组早产儿死亡1例（1.51%），发生肺炎5例（7.57%），颅内出血5例（7.57%），肺出血4例（6.06%），视网膜病变2例（3.03%）；B组早产儿死亡0例（0.00%），发生肺炎4例（6.06%），颅内出血1例（1.51%），肺出血5例（7.57%），视网膜病变3例（4.54%）；2组早产儿肺炎、肺出血、视网膜病变发生率及病死率比较差异均无统计学意义（χ2=1.653、2.987、1.839、2.317，P>0.05），但B组早产儿颅内出血发生率低于A组（χ2=7.158，P<0.05）。结论　手动气囊加压通气和呼吸机机械通气下应用PS治疗RDS早产儿均会出现短暂性SCO2水平升高，但呼吸机机械通气对患儿脑血管自主神经调节功能影响较小，且能降低颅内出血发生率。
Abstract:
Objective　To investigate the effect of different ventilation modes on cerebral oxygen metabolism in premature infants with respiratory distress syndrome （RDS） treated with pulmonary surfactant （PS）.Methods　A total of 132 preterm infants with RDS in Zhumadian Central Hospital from January 2015 to January 2018 were selected as the research subjects.The preterm infants were divided into group A and group B according to the ventilation mode during the application of PS，66 cases in each group.The preterm infants in the group A were treated with PS by manual balloon pressure ventilation，while the preterm infants in the group B were treated with PS by ventilator continuous mechanical ventilation.The cerebral oxygen saturation （SCO2） was monitored by near infrared spectroscopy monitor，and the mean arterial pressure （MAP） was monitored by arterial catheter during the treatment.The SCO2 and the correlation coefficient between SCO2 and MAP（rSCO2-MAP） at 5 minutes before medication，during medication and 5，10 minutes after medication and the complication rate were compared between the two groups.Results　The SCO2 of preterm infants during medication and 5 minutes after medication was significantly higher than that at 5 minutes before medication and 10 minutes after administration in the two groups （P<0.05）.There was no significant difference in the SCO2 of preterm infants between 10 minutes after administration and 5 minutes before medication in the two groups （P>0.05）.There was no significant difference in SCO2 of preterm infants between the two groups at 5 minutes before medication，during medication，5 and 10 minutes after medication （P>0.05）.The rSCO2-MAP during medication was significantly higher than that at 5 minutes before medication and 10 minutes after medication in the two groups （P<0.05）.There was no significant difference in rSCO2-MAP between 10 minutes after medication and 5 minutes before medication in the two groups （P>0.05）.There was no significant difference in rSCO2-MAP between the two groups at 5 minutes before medication，during medication，5 and 10 minutes after during medication （P>0.05）.There was 1（1.51%） case of death，5（7.57%） cases of pneumonia，5（7.57%） cases of intracranial hemorrhage，4（6.06%） cases of pulmonary hemorrhage and 2（3.03%） cases of retinopathy in the group A.There was 0（0.00%） case of death，4（6.06%） cases of pneumonia，1（1.51%） case of intracranial hemorrhage，5（7.57%） cases of pulmonary hemorrhage and 3（4.54%） cases of retinopathy in the group B.There was no significant difference in the incidence of pneumonia，pulmonary hemorrhage，retinopathy and death between the two groups （χ2=1.653，2.987，1.839，2.317；P>0.05）；but the incidence of intracranial hemorrhage in the group B was lower than that in the group A （χ2=7.158，P<0.05）.Conclusion　Both manual balloon pressure ventilation and ventilator mechanical ventilation can increase the SCO2 level of preterm infants with RDS during the application of PS，but ventilator mechanical ventilation has little effect on the autonomic nervous regulation function of cerebral vessels，and can reduce the incidence of intracranial hemorrhage.

参考文献/References:

［1］　杜风玲，董文斌，赵帅，等.布地奈德联合猪肺磷脂注射液预防早产儿支气管肺发育不良［J］.中华实用儿科临床杂志，2016，31（11）：846-850.
［2］　ROTTA A T，PIVA J P.Pediatric acute respiratory distress syndrome：much more than little acute respiratory distress syndrome［J］.Pediatr Crit Care Med，2015，16（5）：483-484.
［3］　刘成军，杜语慧.急性呼吸窘迫综合征的肺表面活性物质治疗现状和再认识［J］.中华实用儿科临床杂志，2016，31（18）：1372-1375.
［4］　梅玲华，刘增芳.盐酸氨溴索联合肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效观察［J］.海南医学院学报，2015，21（1）：59-60，64.
［5］　BEURSKENS C J，WSTEN-VAN ASPEREN R M，PRECKEL B，et al.The potential of heliox as a therapy for acute respiratory distress syndrome in adults and children：a descriptive review［J］.Respiration，2015，89（2）：166-174.
［6］　陈群娥，徐艳，刘建平，等.肺表面活性物质在预防新生儿呼吸窘迫综合征中的临床价值［J］.广西医科大学学报，2016，33（2）：317-319.
［7］　CHEN W，JANZ D R，BASTARACHE J A，et al.Prehospital aspirin use is associated with reduced risk of acute respiratory distress syndrome in critically ill patients：a propensity-adjusted analysis［J］.Crit Care Med，2015，43（4）：801-807.
［8］　王雪，沈锋.不同潮气量机械通气对急性呼吸窘迫综合征家兔凝血/纤溶的影响［J］.中华危重病急救医学，2015，27（7）：585-590.
［9］　蔡志勇，刘进娣，卞洪亮，等.不同时间应用“气管插管-使用肺表面活性物质-拔管使用持续呼吸道正压通气”技术在呼吸窘迫综合征高危早产儿中的疗效［J］.中华实用儿科临床杂志，2016，31（2）：101-104.
［10］　徐腾霄，杨建中，彭鹏.急性呼吸窘迫综合征机械通气时不同呼气末正压水平对每搏量变异度的影响［J］.中华急诊医学杂志，2016，25（3）：305-309.
［11］　郭晓夏，安友仲.急性呼吸窘迫综合征患者机械通气保留自主呼吸的利弊与时机［J］.中华危重病急救医学，2015，27（9）：781-784.

相似文献/References:

[1]薄涛,宋继宁,郑大铭.早产儿颅内出血58例影响因素分析[J].新乡医学院学报,2005,22(03):262.
[2]牛志民.多潘立酮干预早产儿喂养不耐受30例疗效观察 [J].新乡医学院学报,2007,24(02):196.
[3]牛志民.苯巴比妥早期干预早产儿黄疸66例 [J].新乡医学院学报,2007,24(03):265.
[4]徐淑岩,牛菲菲.早产儿呼吸暂停的观察与护理[J].新乡医学院学报,2008,25(02):207.
[5]唐成和,李树军,刘爱娟,等.早产极低出生体质量儿早期微量喂养[J].新乡医学院学报,2008,25(04):394.
[6]王锦华,杨秀艺,乔波涛.早期干预对早产儿脑性瘫痪发生的影响[J].新乡医学院学报,2009,26(04):401.
[7]李卫东,钟晓,迟春昕,等.胎龄34周以上胃肠内喂养不耐受新生早产儿合理喂养方式研究[J].新乡医学院学报,2011,28(01):060.
[8]刘超,张桂欣.肺表面活性物质治疗晚期早产儿呼吸窘迫综合征疗效观察[J].新乡医学院学报,2012,29(08):623.
[9]李明超,邢　珊.早产儿脑损伤、母亲绒毛膜羊膜炎及脐动脉血白细胞介素-6水平的关系[J].新乡医学院学报,2016,33(10):875.[doi:10.7683/xxyxyxb.2016.10.010]
　LI Ming-chao,XING Shan.Relationship among brain injury of preterm infant,maternal chorioamnionitis and interleukin-6 level in umbilical artery blood[J].Journal of Xinxiang Medical University,2016,33(12):875.[doi:10.7683/xxyxyxb.2016.10.010]
[10]信　军,康　乐,张艺森,等.重组人促红细胞生成素对早产儿脑损伤的防治作用[J].新乡医学院学报,2018,35(10):928.[doi:10.7683/xxyxyxb.2018.10.020]
　XIN Jun,KANG Le,ZHANG Yi-sen,et al.Preventive effect of recombinant human erythropoietin on brain injury in premature infants[J].Journal of Xinxiang Medical University,2018,35(12):928.[doi:10.7683/xxyxyxb.2018.10.020]
[11]王自珍,雷　娜,张　敏.不同剂量猪肺磷脂注射液雾化吸入联合无创辅助通气治疗早产儿呼吸窘迫综合征疗效观察[J].新乡医学院学报,2022,39(1):067.[doi:10.7683/xxyxyxb.2022.01.014]
　WANG Zizhen,LEI Na,ZHANG Min.Effect of different doses of poractant alfa injection atomization inhalation combined with non-invasive auxiliary ventilation in the treatment of premature infants with respiratory distress syndrome[J].Journal of Xinxiang Medical University,2022,39(12):067.[doi:10.7683/xxyxyxb.2022.01.014]
[12]张晓荣,戴红霞,魏红艳,等.呼吸窘迫综合征早产儿血清Clara细胞分泌蛋白水平变化及意义[J].新乡医学院学报,2020,37(4):347.[doi:10.7683/xxyxyxb.2020.04.010]
　ZHANG Xiaorong,DAI Hongxia,WEI Hongyan,et al.Changes and significance of serum Clara cell secretory protein in preterm infants with respiratory distress syndrome[J].Journal of Xinxiang Medical University,2020,37(12):347.[doi:10.7683/xxyxyxb.2020.04.010]
[13]张　冰,张卫星,常绍鸿,等.鼻塞式高频振荡通气治疗早产儿呼吸窘迫综合征疗效观察[J].新乡医学院学报,2017,34(6):519.[doi:10.7683/xxyxyxb.2017.06.018]
　ZHANG Bing,ZHANG Wei-xing,CHANG Shao-hong,et al.Effect of nasal high frequency oscillatory ventilation in the treatment of premature infants with respiratory distress syndrome[J].Journal of Xinxiang Medical University,2017,34(12):519.[doi:10.7683/xxyxyxb.2017.06.018]

更新日期/Last Update: 2018-12-05