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目的探讨机械通气对极低出生体重儿脑室内出血的影响及机制。方法选取2003年1月至2005年12月在深圳市人民医院儿科住院的机械通气极低出生体重儿33例及同期住院的无机械通气极低出生体重儿33例,比较两者脑室内出血的发生率,并通过对机械通气下极低出生体重儿发生脑室内出血(11例)与无脑室内出血22例)的PIP、PEEP、MAP、通气天数及低血压比较,探讨机械通气对极低出生体重儿脑室内出血影响的发生机制。结果机械通气的极低出生体重儿脑室内出血和重度脑室内出血的发生率为66.7%和18.2%;无机械通气的极低出生体重儿脑室内出血发生率为33.3%,无重度脑室内出血。机械通气下极低出生体重儿发生脑室内出血与无脑室内出血者吸气峰压、呼吸末正压、平均气道压力、通气天数的比较无明显差异,当收缩压低于45mmHg时,极低出生体重儿发生脑室内出血较不发生脑室内出血明显增多。结论机械通气是导致极低出生体重儿脑室内出血发生和加重的危险因素,临床使用机械通气时,尽量维持患儿收缩压45mmHg以上,避免或减轻脑室内出血的发生或发展。
Objective To investigate the effect of mechanical ventilation on intraventricular hemorrhage in very low birth weight infants and its mechanism. Methods From January 2003 to December 2005, 33 cases of mechanically ventilated and very low birth weight children hospitalized in pediatric department of Shenzhen People’s Hospital and 33 patients without mechanical ventilation and very low birth weight who were hospitalized in the same period were enrolled. The incidence of intraventricular hemorrhage Rate, PIP, PEEP, MAP, days of ventilation and hypotension were compared between ventricular hemorrhage (11 cases) and no-ventricle hemorrhage in very low birth weight infants under mechanical ventilation. To investigate the effects of mechanical ventilation on very low birth weight The mechanism of the impact of intraventricular hemorrhage. Results The incidence of ventricular hemorrhage and severe intraventricular hemorrhage in very low birth weight children with mechanical ventilation was 66.7% and 18.2%, respectively. The incidence of intraventricular hemorrhage in very low birth weight children without mechanical ventilation was 33.3% with no severe intraventricular hemorrhage. There was no significant difference in peak inspiratory pressure, positive end-expiratory pressure, mean airway pressure and days of ventilation between intraventricular hemorrhage and intraventricular hemorrhage in very low birth weight infants under mechanical ventilation. When systolic blood pressure was lower than 45mmHg, very low birth weight Occurrence of intraventricular hemorrhage occurred in children with intraventricular hemorrhage was significantly increased. Conclusion Mechanical ventilation is a risk factor for the occurrence and aggravation of intraventricular hemorrhage in very low birth weight children. When mechanical ventilation is used clinically, the systolic blood pressure above 45mmHg should be maintained to avoid or reduce the occurrence or development of intraventricular hemorrhage.