高频振荡通气加常频通气治疗早产儿肺透明膜病的临床和护理研究.doc

高频振荡通气加常频通气治疗早产儿肺透明膜病的临床和护理研究 2012年第16卷第2期实用临床医药杂志 JoumalofCIinicalMedicineinPractice?89? 高频振荡通气加常频通气治疗 早产JLn$透明膜病的临床和护理研究 叶蕾,杨小红,孙,J,娟 (江苏省南通市第一人民医院儿科,江苏南通,226001) 摘要:目的研究高频振荡通气加常频通气治疗早产儿肺透明膜病的l临床疗效和护理特点.方法以2009年1月～ 2010年l2月在本院新生儿重症监护室(NICU)住院采用机械通气治疗的18例早产儿肺透明膜病(HMD)患儿为研究对象,随 机分为研究组10例和对照组8例,研究组通气模式为高频振荡通气加常频通气,对照组采用为常频通气模式,比较两组患儿匕 机后临床疗效,呼吸机参数,氧合指标以及气胸,颅内出血等并发症的发生率,同时总结高频振荡通气加常频通气的护理特点 和体会.结果研究组上机24h后吸氧浓度(FiO2),平均气道压力(MAP),氧合指数(0I)和l临床转归均优于对照组(Plt;0. 05);研究组气胸发生率低于对照组(Plt;0.05);颅内出血发生率两者无显着性差异(Pgt;0.05).结论高频叠加常频通气模 式能提高HMD患儿的氧合,改善临床转归,降低气胸的发生率,而且不增加颅内出血的发生,疗效明显优于常频通气模式.同 时治疗过程中优质的机械通气相关护理配合是抢救成功的重要因素. 关键词:高频振荡通气;常频机械通气;肺透明膜病;早产儿 中图分类号:R473.72文献标志码:A文章编号:1672—2353(2012)02—0089—03 ClinicalnursingofHFOVplusCMVon prematurenewbornswithhyalinemembranedisease YELei,YANGXiao—hong,SUNXiao～juan (NantongNo.1PeopleHospital,Nantong,Jiangsu,226001) ABS11RACT:objectiveTostudytheeffectandnursingstrategiesofhighfrequencyoscillato— ryventilation(HFOV)plusconventionalmandatoryventilation(CMV)ontreatingcriticalhyaline membranedisease(HMD).MethodsAtotalof18infantswithcritica1HMDintheNICUfrom January2009toDecember2010wereenrolledanddividedintotreatmentgroup(HFOVplusCMV) andcontrolgroup(CMV).Clinicalefficacy,ventilatorparameters,bloodgasanalysisandcomplica— tions(pneumothorax,intracranialhemorrhage)werecomparedbetweenthetwogroups.Nursing strategiesweresummarizedaccordingly.ResultsAfter24htreatment,PCh,M,oIandout— comeofthetreatmentgroupwerebetterthanthoseofthecontrolgroup(Plt;0.05).Compared withthecontrolgroup,theincidenceofpneumothoraxinthetreatmentgroupwassignificantlylow— er(Plt;0.05).Butnostatisticalsignificancewasfoundinincidenceofintracranialhemorrhagebe— tweenthetwogroups(Plt;0.05).ConclusionHFOVplusCMVcanimprovelungoxygenation andclinicaloutcome,andreducetheincidencerateofpneumothoraxwithoutincreasingtheriskof intracranialhemorrhage.Theeffectissuperiortoconventionalmandatoryventilation.Duringthe treatmentprocess,nursingcooperationrelatedtohigh—qualitymechanicaIventilationispara