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目的:探讨新生儿允许性高碳酸血症(PHC)时脑血流的变化。方法:观察深圳市龙岗区妇幼保健院及深圳市人民医院需机械通气的60例新生儿呼吸窘迫综合征(NRDS)住院早产患儿并随机分为两组,每组30例。观察组在呼吸机治疗期间,根据临床反应、血气分析结果、呼吸机参数(以降低潮气量为主)相互关系,最终调节达pH 7.30~7.40、PaCO246~60 mmHg的PHC;对照组以同样的方式维持pH 7.35~7.45、PaCO235~45 mmHg,两组PaO2均维持在50~100 mmHg。所有患儿在24~72 h内做大脑中动脉血流检测,测量参数包括收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、收缩期血流速度与舒张末期血流速度的比值(S/D)、早期阻力指数(RI)及搏动指数(PI)。结果:两组患儿对脑血流有影响的因素比较差异无统计学意义(P>0.05)。通气策略改变前,两组呼吸机参数比较差异无统计学意义(P>0.05);通气策略改变后,观察组患儿平均气道压(MAP)和吸气压峰值(PIP)、吸气时间(Ti)下降,两组比较差异有统计学意义(P<0.05)。两组血气检测结果比较:观察组pH值低于对照组,PaCO2高于对照组,差异有统计学意义(P<0.05);而两组PaO2/FiO2、PaO2、心率和血压比较差异无统计学意义(P>0.05)。两组患儿脑血流Vs、Vd、S/D、RI、PI比较差异无统计学意义(P>0.05)。结论:只要维持血循环稳定、PaO250~100 mmHg,患儿脑血流参数改变不明显,PHC通气策略治疗NRDS是安全、可行的。
Objective: To investigate the changes of cerebral blood flow in neonatal permissive hypercapnia (PHC). Methods: Sixty neonates with respiratory distress syndrome (NRDS) undergoing mechanical ventilation in Longgang District MCH and Shenzhen People’s Hospital were enrolled and randomly divided into two groups (n = 30 in each group). During the treatment of ventilator, the observation group finally adjusted PHC up to pH 7.30-7.40 and PaCO246-60 mmHg according to the clinical response, blood gas analysis results and ventilator parameters (mainly to reduce the tidal volume); in the same way Maintained pH 7.35 ~ 7.45, PaCO235 ~ 45 mmHg, PaO2 in both groups maintained at 50 ~ 100 mmHg. All children underwent middle cerebral artery blood flow measurement within 24-72 h. Measurement parameters included systolic peak flow velocity (Vs), end-diastolic flow velocity (Vd), systolic flow velocity and end-diastolic flow velocity (S / D), early resistance index (RI) and pulsatility index (PI). Results: There was no significant difference in cerebral blood flow between the two groups (P> 0.05). Ventilation parameters before the change in the two groups were no significant differences in ventilator parameters (P> 0.05); changes in ventilation strategy, the observation group children with mean airway pressure (MAP) and peak inspiratory pressure (PIP), inspiratory time (Ti) decreased, the difference between the two groups was statistically significant (P <0.05). PaO2 was higher in the observation group than in the control group, and the difference was statistically significant (P <0.05). There was no significant difference in PaO2 / FiO2, PaO2, heart rate and blood pressure between the two groups Significance (P> 0.05). There was no significant difference in Vs, Vd, S / D, RI and PI between the two groups (P> 0.05). CONCLUSION: As long as blood circulation is stable, PaO250 ~ 100 mmHg does not change the parameters of cerebral blood flow in children. PHC ventilation strategy is safe and feasible.