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目的探讨新生儿机械通气撤机时肺力学指标的范围及临床意义。方法通过Bicore-CP 100呼吸功能监测仪测定32例机械通气撤机时的新生儿在CPAP模式、脱机拔管前及拔管后20 min等条件下的肺力学指标范围,根据拔管48 h内是否重新插管并分为撤机成功组与失败组。结果成功组的呼吸力学范围为:气道阻力(Rawmean)(93.7±14.3)cmH2O/(L.s)、呼吸系统顺应性(Crs)(0.65±0.09)ml/(cmH2O.kg)、患者呼吸功(WOBp)(1 589±133.2)g.cm/(min.kg);失败组为:Rawmean(98.6±15.5)cmH2O/(L.s)、Crs(0.57±0.08)ml/(cmH2O.kg)、WOBp(1 782±148.6)g.cm/(min.kg)。Crs与WOBp两组差异有显著性。Crs(0.65±0.09)ml/(cmH2O.kg),脱机成功率95.4%。撤机后拔管前两组平均WOB为(1 768±186.4)g.cm/(min.kg),Crs为(0.624±0.11)ml/(cmH2O.kg),脱机成功率为81.25%。结论肺力学的检测对新生儿呼吸机的撤离具有指导作用,特别是呼吸系统顺应性和呼吸功的检测更具有实质意义。
Objective To explore the range and clinical significance of pulmonary mechanics indexes during neonatal mechanical ventilation with weaning. Methods Bicore-CP 100 respiratory function monitor 32 mechanical ventilation during weaning neonatal CPAP mode, before and after extubation extubation 20 min and other conditions under the conditions of pulmonary mechanics, according to extubation 48 h Within re-intubation and divided into weaning success group and failure group. Results In the successful group, the respiratory mechanics range was: Rawmean (93.7 ± 14.3) cmH2O / (Ls), Respiratory compliance (0.65 ± 0.09) ml / (cmH2O.kg) (989 ± 15.5) cmH2O / (Ls), Crs (0.57 ± 0.08) ml / (cmH2O.kg), WOBp (1 589 ± 133.2) g.cm/ 1 782 ± 148.6) g.cm/ (min.kg). There was significant difference between Crs and WOBp. Crs (0.65 ± 0.09) ml / (cmH2O.kg), off-line success rate of 95.4%. The average WOB of the two groups after extubation was (1 768 ± 186.4) g.cm/ (min.kg), Crs was (0.624 ± 0.11) ml / (cmH2O.kg), and the off-line success rate was 81.25%. Conclusion The detection of pulmonary mechanics plays a guiding role in the evacuation of neonatal ventilator. In particular, the detection of respiratory compliance and respiratory work has more practical significance.