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目的比较比例辅助通气(PAV)和同步间歇指令通气(SIMV)在新生儿胎粪吸入综合征(MAS)应用时相关临床指标变化。方法 30例符合MAS诊断且需要呼吸支持的新生儿随机分为PAV组和SIMV组,每组15例,分别给予PAV模式和SIMV模式支持;观察通气前、通气后1h、12h、24h、48h和撤机前的心率(HR)、呼吸频率(RR)、平均动脉血压(MABP)、潮气量(VT)、每分通气量(MV)、平均气道压(MAP)、气道峰压(PIP)、动脉血气值及氧合指数(OI)。结果两组新生儿均治愈出院;在机械通气时间(F=1.425,P=0.243)、吸氧时间(F=3.057,P=0.091)、住院时间(F=0.148,P=0.703)和胸部X线清晰时间(F=0.315,P=0.579)方面,两组数值的差异均无统计学意义。在取得相同疗效情况下,机械通气后PAV组各个时间点:RR数值均显著高于SIMV组(P均<0.05);MAP、PIP和VT数值均显著低于SIMV组(P均<0.05);HR、MABP、MV、PH和OI数值与SIMV组比较差异均无统计学意义(P均>0.05)。结论 PAV和SIMV模式治疗MAS时,在取得相同疗效情况下,PAV模式采取浅快的呼吸、较小的潮气量和较低的MAP和PIP。
Objective To compare the changes of clinical indicators of neonatal meconium aspiration syndrome (MAS) with proportional assisted ventilation (PAV) and synchronized intermittent mandatory ventilation (SIMV). Methods Thirty newborns with MAS diagnosis and requiring respiratory support were randomly divided into PAV group and SIMV group, 15 cases in each group. PAV mode and SIMV mode were given respectively. Before ventilation, 1 hour, 12 hours, 24 hours, 48 hours after ventilation and (HR), respiratory rate (RR), mean arterial pressure (MABP), tidal volume (VT), MV, mean airway pressure ), Arterial blood gas and oxygenation index (OI). Results Both neonates were cured and discharged during the period of mechanical ventilation (F = 1.425, P = 0.243), oxygen inhalation time (F = 3.057, P = 0.091), hospitalization time Line clear time (F = 0.315, P = 0.579), no significant difference between the two groups of values. After achieving the same curative effect, the RR values of PAV group after mechanical ventilation were significantly higher than those of SIMV group (all P <0.05); the values of MAP, PIP and VT were significantly lower than those of SIMV group (all P <0.05); The values of HR, MABP, MV, PH and OI were not significantly different from SIMV group (all P> 0.05). Conclusions In the treatment of MAS with PAV and SIMV modes, PAV mode takes shallow breath, smaller tidal volume and lower MAP and PIP with the same curative effect.