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目的探讨呼吸窘迫综合征(RDS)极低出生体重儿在不同机械通气模式下心功能的变化。方法选择本院新生儿重症监护病房2009年1月至2012年12月收治的RDS极低出生体重儿为研究对象。根据随机号将患儿分为高频振荡通气组(HFOV)和常频机械通气组(CMV)两组。在通气8~12 h、生命体征相对稳定后,采用彩色多普勒超声对两组患儿心脏泵血功能进行评价,包括心输出量(CO)、左室射血分数(EF)、每搏输出量(SV)、收缩期主动脉瓣峰值流速(AV)、收缩期肺动脉瓣峰值流速(PV)、舒张期二尖瓣口峰值流速(MV)和舒张期三尖瓣口峰值流速(TV)。结果研究期间共收治极低出生体重儿合并RDS者152例,89例符合入选标准,其中47例在研究过程中被排除,两组最终完成研究的例数均为21例。HFOV组胎龄(29.8±1.6)周,出生体重(1335±98)g;CMV组胎龄(28.7±1.8)周,出生体重(1344±115)g。两组胎龄、日龄、体重、心率、经皮血氧饱和度、血压、血气分析和RDS分度等方面差异均无统计学意义(P>0.05)。HFOV组MAP高于CMV组[(9.5±1.2)cmH2O比(7.2±0.6)cmH2O,P<0.05];心功能方面,HFOV组PV和MV均低于CMV组[(0.53±0.15)m/s比(0.66±0.18)m/s,(0.53±0.22)m/s比(0.71±0.07)m/s,P<0.05],两组CO、EF、SV、AV及TV差异均无统计学意义(P>0.05)。结论HFOV组MAP增高,可降低右室收缩功能及左室舒张功能,但对左室收缩射血功能无明显影响。
Objective To investigate the changes of cardiac function in very low birth weight children with respiratory distress syndrome (RDS) under different mechanical ventilation patterns. Methods The RDS patients with very low birth weight who were admitted to our Neonatal Intensive Care Unit from January 2009 to December 2012 were selected as the study subjects. The children were divided into high-frequency oscillatory ventilation group (HFOV) and constant-frequency mechanical ventilation group (CMV) according to random number. After 8 to 12 hours of ventilation and vital signs were relatively stable, color Doppler echocardiography was used to evaluate the cardiac pump function in both groups, including cardiac output (CO), left ventricular ejection fraction (EF), stroke volume (SV), peak systolic aortic flow velocity (AV), systolic pulmonary valve peak flow velocity (PV), diastolic mitral valve peak velocity (MV) and diastolic tricuspid valve peak velocity (TV) . Results A total of 152 patients with very low birth weight infants with RDS were enrolled during the study period, and 89 patients met the inclusion criteria. Of these, 47 patients were excluded from the study. The final number of patients in both groups was 21. The gestational age (29.8 ± 1.6) weeks, birth weight (1335 ± 98) g in HFOV group and gestational age (28.7 ± 1.8) weeks and birth weight (1344 ± 115) g in CMV group, respectively. There was no significant difference in gestational age, age, body weight, heart rate, percutaneous oxygen saturation, blood pressure, blood gas analysis and RDS index between the two groups (P> 0.05). The MAP of HFOV group was higher than that of CMV group [(9.5 ± 1.2) cmH2O vs (7.2 ± 0.6) cmH2O, P <0.05]. In heart function, the PV and MV in HFOV group were lower than that in CMV group [(0.53 ± 0.15) m / s (0.66 ± 0.18) m / s, (0.53 ± 0.22) m / s ratio (0.71 ± 0.07) m / s, P <0.05]. There was no significant difference in CO, EF, SV, AV and TV between the two groups (P> 0.05). Conclusions The MAP of HFOV group is higher than that of the control group, which can reduce the RV systolic function and left ventricular diastolic function, but has no significant effect on the left ventricular systolic ejection function.