中国实用儿科杂志

中国实用儿科杂志 ›› 2012, Vol. 27 ›› Issue (2): 130-133.

• 论著 • 上一篇    下一篇

允许性高碳酸血症通气法中动脉血
二氧化碳分压适宜范围探讨

廖景文   

  1. 福建医科大学附属三明第一医院儿科，福建三明　365000
  • 出版日期:2012-02-06 发布日期:2012-04-12

ppropriate range of arterial blood partial pressure of carbon dioxide in permissive hypercapnia ventilation.　

  • Online:2012-02-06 Published:2012-04-12

摘要：

目的　探讨允许性高碳酸血症通气法在治疗新生儿呼吸窘迫综合征（NRDS）中动脉血二氧化碳分压（PaCO2）的适宜范围。方法　选择2004年1月至2009年12月福建医科大学附属三明第一医院需机械通气治疗的NRDS患者共90例，分3组，每组30例。对照组：PaCO2维持在35～45 mmHg（1 mmHg = 0.133 kPa） ；观察Ⅰ组：PaCO2维持在46～60 mmHg；观察Ⅱ组：PaCO2维持在61～75 mmHg。对3组呼吸机参数设置、血气分析、并发症及疗效等进行对照分析。结果　观察组（Ⅰ组和Ⅱ组）呼吸机参数平均气道压（MAP）、吸气时间（Ti）、吸气峰压（PIP）显著低于对照组（P < 0.01），吸入氧浓度（FiO2）低于对照组（P < 0.05），呼吸频率（RR）高于对照组（P < 0.05）；观察组pH值低于对照组（P < 0.05），PaCO2显著高于对照组（P < 0.01）；观察Ⅰ组PaCO2显著低于观察Ⅱ组（P < 0.01）；而观察组机械通气相关性肺损伤（VALI）的发生率低于对照组（P < 0.05） ，机械通气时间明显较对照组短（P < 0.01），疗效高于对照组（P < 0.05）。3组住院时间和脑室内出血（IVH）和脑室周围白质软化（PVL）发生率的比较，差异无统计学意义（P > 0.05），但对照组和观察Ⅱ组IVH程度严重。结论　应用允许性高碳酸血症通气法治疗NRDS，可降低VALI的发生率，减少机械通气时间，不影响氧合、心率、血压及循环灌注状况，不增加IVH和PVL的发生率，疗效可能更优于传统通气策略，PaCO2 维持中等水平增高范围（46～60 mmHg），发生颅内出血的程度轻，是较适宜的范围。

关键词: 允许性高碳酸血症；呼吸窘迫综合征, 新生儿；动脉血二氧化碳分压

Abstract:

Objective　To study the appropriate range of arterial blood partial pressure of carbon dioxide （PaCO2） in permissive hypercapnia ventilation in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods　From  Jan.2004 to Dec.2009 in Sanming First Hospital Affiliated to Fujian Medical University，90 cases of infants who were treated with mechanical ventilation were randomly divided into three groups： control group（PaCO2 range 35～45 mmHg）（1 mmHg = 0.133 kPa），treatmentⅠgroup（PaCO2 range 46～60 mmHg），treatment Ⅱgroup（PaCO2 range 61～75 mmHg）. Data relevant to the neonates were collected and analyzed ，including the ventilator’s parameter ，blood gas ，complications and therapeutic effectiveness. Results　Mean airway presure （MAP），inspiratory time （Ti） and peak inspiratory presure （PIP） in the treatment group were significantly lower than those in the control group respectively （P < 0.01）；fraction of inspiration O2（FiO2）was lower than that in the control group （P < 0.05）；respiratory rate（RR） was higher than that in the control group （P < 0.05）；pH in treatment group was lower than that in the control group （P < 0.05）；PaCO2 was significantly higher than that in the control group（P < 0.01）；PaCO2 in the treatmentⅠgroup was significantly lower than that in the treatment Ⅱ group （P < 0.01）； the incidence of ventilator associated lung injury （VALI） in treatment groups was lower than that in the control group （P < 0.05），and mechanical ventilation time was significantly lower than that in the control group （P < 0.01）；the therapeutic effectiveness was better than that of the control group （P < 0.05）. There were also no differences in the length of hospitalization ，incidence of intraventricular hemorrhage（IVH） and periventricular leukomalacia（PVL）（P > 0.05），but consequence of IVH in the control group and the treatment Ⅱ group was very serious. Conclusion　Permissive hypercapnia ventilation in the treatment of NRDS can markedly decrease the incidence of VALI and mechanical ventilation time，without affecting oxygenation，heart rate，blood pressure and without increasing the incidence of IVH and PVL；the therapeutic effectiveness is better than that of the conventional mechanical ventilation.Moderate range of PaCO2（46～60 mmHg） is appropriate because of slight IVH .

Key words: permissive hypercapnia；respiratory distress syndrome, newborn；arterial blood partial pressure of carbon dioxide