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动态肺部超声监测早产儿机械通气治疗拔管期中的临床价值
尚彪,覃夏川,刘学彬,田鹏,刘娟,张鸿,何刚,白静,丁小燕
0
(川北医学院第二临床医学院·南充市中心医院新生儿科;川北医学院第二临床医学院·南充市中心医院超声科)
摘要:
【摘要】 目的 探讨采用动态肺部超声监测早产儿(<34孕周)机械通气治疗围拔管期中的作用和临床价值。方法 纳入2014年1月~2017年7月125例需行机械通气治疗的<34孕周的早产儿进入本研究,随机分为超声指导组57例和非超声指导组68例,分析比较两组间机械通气拔管的成功率、安全性及拔管后不良反应发生率。结果 超声指导组机械通气拔管成功率明显高于非超声指导组(930% vs. 765%,P=0014),其中超声指导组机械通气拔管显效明显高于非超声指导组(561% vs. 324%,P=0011),非超声指导组机械通气拔管无效率高于超声指导组(220% vs.70%,P=0024)。拔管后不良反应比较,超声指导组拔管后心动过速、烦躁不安、喂养不耐受明显低于非超声指导组(分别为53% vs. 162%,P=0048,35% vs. 147%,P=0032 和191% vs. 70%,P=0042),电解质紊乱、高血糖发生率在两组间无统计学差异(P>005)。结论 连续动态肺部超声监测能评估<34孕周早产儿肺部病变的进程,可辅助机械通气量和拔管时机的选择、指导不同剂量枸橼酸咖啡因药物剂量应用于拔管,并能提高拔管成功率,降低拔管中和拔管后出现的不良反应。
关键词:  肺部超声  早产儿  机械通气  拔管  成功率  并发症
DOI:
基金项目:南充市应用技术研究与开发资金项目(16YFZJ0030)
Clinical value of continuous dynamic pulmonary ultrasonography in mechanical ventilation during the extubation period in preterm infants
SHANG Biao,QIN Xiachuan,LIU Xuebin,TIAN Peng,LIU Juan,ZHANG Hong,HE Gang,BAI Jing,DING Xiaoyan
(Department of Neonatology, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College;Department of Ultrosound, Nanchong Central Hospital, The Second Clinical College of North Sichuan Medical College)
Abstract:
【Abstract】 Objective To investigate the clinical value of monitoring perioperative period of mechanical ventilation extubation in preterm infants with less than 34 weeks using continuous dynamic lung ultrasound. Methods In January 2014July 2017, 125 preterm infants who need mechanical ventilation for <34 gestational weeks are enrolled in this study. They were divided into ultrasound guidance group (57 cases) and non ultrasound guidance group (68 cases). The mechanical ventilation tube drawing success rate, safety, and the incidence of adverse reactions after extubation were observed.Results Compared with non ultrasound guidance group, ultrasound guidance group had high success to remove mechanical ventilation (930% vs. 765%,P=0014). Moreover, ultrasound guidance group had more markedly efficacy and less invalid than that of non ultrasound guidance group during mechanical ventilation extubation. The incidence of tachycardia, irritability and feeding intolerance in non ultrasound guidance group were higher than that i ultrasound guidance group. There had no difference on electrolyte disorder and hyperglycemia between the two groups (all P>005). Conclusion This study demonstrates that continuous dynamic lung ultrasound for monitoring perioperative period of mechanical ventilation extubation in preterm infants with less than 34 weeks can be well assessed the process of lung disease, help adjusting the volume of mechanical ventilation and selection of extubation time, supervises different dose of caffeine citrate applied to extubation, and improve the success ratio on removing mechanical ventilation and declined the incidence of adverse reactions.
Key words:  Lung ultrasound  Preterm infants  Mechanical ventilation  Extubation  Efficacy  Complication

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