周海燕　胡金绘　武荣

[摘要] 目的 观察压力调节容量控制（PRVC）和容量控制（VC）两种通气模式在治疗新生儿呼吸窘迫综合征（NRDS）时的相关参数变化，评估PRVC在NRDS治疗中的优势。 方法 选择2014年5月～2015年3月扬州大学医学院附属淮安市妇幼保健院新生儿医学中心住院32例新生儿呼吸窘迫综合征患儿为研究对象，根据呼吸机模式选择不同分为PRVC组（PRVC模式通气，n=17）和VC组（VC模式通气48 h后改PRVC模式通气，n=15），其他的呼吸机参数设置相同。观察两组患儿的出生体重、胎龄、机械通气时间、吸氧时间及平均住院时间；观察机械通气前、机械通气6、24、48 h患儿的呼吸频率、心率及平均动脉压血压，机械通气1、6、2、48 h的气道峰压和氧合指数的变化，以及机械通气时PH值<7.35、pH值>7.45、低碳酸血症（PCO2<35 mmHg）和高碳酸血症（PCO2>60 mmHg）的发生率。 结果 32例患儿均痊愈出院。两组患儿出生体重、胎龄、机械通气时间、吸氧时间及平均住院时间比较，差异均无统计学意义（P > 0.05）。两组患儿的心率整体呈下降趋势，并且在机械通气48 h时接近正常范围（120～140次/min），各个时间点整体比较差异有高度统计学意义（F=4.381，P < 0.01）；呼吸次数整体呈下降趋势，并且在机械通气48 h点接近正常范围（35～60次/min），各个时间点整体比较差异有高度统计学意义（F=10.390，P < 0.01）；平均动脉血压各个时间点整体比较差异无统计学意义（P > 0.05）。PRVC组气道峰压在机械通气1、6、24 h时均低于VC组，差异均有统计学意义（P < 0.05）；氧合指数数值整体呈下降趋势，机械通气1 h时，PRVC组与VC组比较，差异无统计学意义（P > 0.05），机械通气6、24、48 h时差异均有统计学意义（P < 0.05）；机械通气时两组pH值>7.45和pH值<7.35的发生率比较，差异均无统计学意义（P > 0.05）；机械通气时两组PCO2>60 mmHg和PCO2<35 mmHg的发生率比较，差异无统计学意义（P > 0.05）。 结论 与VC模式比较，PRVC模式治疗NRDS时具有较低的气道峰压，可能降低肺气压伤的发生，是一种肺保护性通气模式。

[关键词] 压力调节容量控制；容量控制；肺损伤；新生儿呼吸窘迫综合征

[中图分类号] R725.6 [文献标识码] A [文章编号] 1673-7210（2015）08（c）-0111-05

[Abstract] Objective To observe the advantages of pressure regulated volume control （PRVC） ventilation by comparing the related parameter variables which on the PRVC ventilation and on the volume control （VC） ventilation in treatment of neonatal respiratory distress syndrome （NRDS）. Methods 32 cases of neonatal respiratory distress syndrome from May 2014 to March 2015 in Neonatal Medical Center of Huai'an Maternity and Child Healthcare Hospital Affiliated to Yangzhou University Medical Academy were selected as the research objects， they were divided into the PRVC group （PRVC ventilation， n = 17） and VC group （PRVC ventilation after VC mode for 48 hours instead， n = 15） according to different breathing machine mode. Apart from the PRVC/VC mode， ventilator settings were comparable. The gestational age， weight， mechanical ventilation time， oxgyen cure time， hospital stay were observed. Respiratory rate， heart rate， mean arterial blood pressure were observed before and 6， 24， 48 hours after ventilation. Peak inspiratory pressure and oxygenation index were observed at 1， 6， 24， 48 hours after ventilation in both groups. The incidence of pH<7.35， pH>7.45 and low carbonate （PCO2<35 mmHg） and hyperapnia （PCO2>60 mmHg） in two groups were compared. Results All 32 patients were recovered， there were no statistically significant differences between the two groups in the time of mechanical ventilation time， oxyen cure time， the hospitalization time （P > 0.05）. Heart rates were on the decline as a whole， and closed to the normal range at 48 hours （120-140 times/min）. There was statistically significant difference at all time points in the whole comparison （F=4.381， P < 0.01）； respiratory rates were on the decline as a whole， and closed to the normal range at 48 hours （35-60 times/min）， there was statistically significant at all time points in the whole comparison （F=10.390， P < 0.01）. Mean arterial blood pressure was no statistically significant difference at all time points in the whole comparison （P > 0.05）. Peak inspiratory pressure was lower during PRVC ventilation than during VC ventilation at 1， 6， 24 hours after ventilation. The PIP difference between the two groups was statistically significant （P < 0.05）； The oxygenation index was on the decline， there was no statistically significant difference at 1 hour time point between two groups （P > 0.05）， but at 6，24，48 hours time points there was statistically significant between the two groups （P < 0.05）. No statistically significant difference was found between the incidence of pH>7.45 and pH<7.35 when at the mechanical ventilation in two groups （P > 0.05）. There was no statistically significant difference in the incidence of PaCO2>60 mmHg when at mechanical ventilation between two groups （P > 0.05）. Conclusion The peak inspiratory pressure was reduced on the PRVC ventilation than on the VC ventilation in the treatment of NRDS. PRVC reduced the incidence of pulmonary barotraumas probably. So it is a lung protective ventilation mode.

[Key words] Pressure regulated volume control ventilation； Volume control ventilation； Barotrauma； Neonatal respiratory distress syndrome

呼吸机相关性肺损伤是指机械通气本身诱发的肺损伤，在应用机械通气的新生儿中有较高的发病率，是增加新生儿病死率和住院时间的重要原因。压力……