【作者】 张磊；

【导师】 薛辛东；

【作者基本信息】 中国医科大学 ， 儿科学， 2010， 硕士

【摘要】 目的探讨机械通气对极低和超低出生体重儿脑损伤的影响及机械通气下极低和超低出生体重儿脑损伤发生或加重的高危因素。方法回顾分析中国医科大学盛京医院新生儿病房于2007年3月至2009年12月收治的需行机械通气治疗的极低和超低出生体重儿82例,并随机选取同期住院的82例未行机械通气极低和超低出生体重儿的临床及影像学资料,比较两组脑损伤的发生率；同时将机械通气患儿按脑损伤形式分为非脑实质出血组、脑白质损伤组及非脑损伤组,对三组患儿在呼吸机参数(最高PIP、最高PEEP、RR)、血气指标(最高Pa02、最低Pa02、最高PaC02、最低PaC02)、通气时间等指标作比较,探讨机械通气对极低和超低出生体重儿脑损伤的影响因素。结果机械通气组患儿脑损伤总的发生率、非脑实质出血发生率及脑白质损伤发生率分别为71.95%、45.12%(重度颅内出血的发生率为9.76%)、26.82%；非机械通气组患儿脑损伤总的发生率、非脑实质出血发生率及脑白质损伤发生率分别为37.80%、25.61%(重度颅内出血的发生率为2.44%)、12.20%；机械通气条件下三组极低出生体重儿在最高PIP、最高PEEP、最高Pa02、最低Pa02、呼吸频率、上机时间等方面无统计学意义(P>0.05),但非脑实质出血组与非脑损伤组最高PaCO2及平均动脉压有统计学意义(P<0.05)；脑白质损伤组与非脑损伤组在最低二氧化碳分压方面有统计学意义(P<0.05)。结论机械通气组极低和超低出生体重儿脑损伤的发生率明显高于非机械通气组；机械通气下极低和超低出生体重儿脑损伤仍以非脑实质出血为主,其次为脑白质损伤；机械通气时所致的高碳酸血症及低碳酸血症可能是极低和超低出生体重儿脑损伤发生或加重的高危因素。更多还原

【Abstract】 ObjectiveTo explore the influence of mechanical ventilation on brain injury in very low and extremely low birth weight(VLBW and ELBW) infant and risk factors related brain damage in VLBW and ELBW infants with mechanical ventilation.MethodsThe study was prospectively performed on 82 VLBW and ELBW infants with mechanical ventilation and 82 VLBW and ELBW infants without mechanical ventilation at the same period from March 2007 to December 2009 at the neonatal intensive care unit of the Shengjing Hospital of China Medical University. Detailed clinical and imaging data of all subjects were analyzed,the rate of brain injury between the two groups was compared. The 82 VLBW and ELBW infants with mechanical ventilation were divided into three groups:non-cerebral hemorrhage group (37)、and white matter damage(WMD) group (22)and non-injury group (23). The highest and lowest values of PaCO2、PaO、the highest values of PIP, PEEP, respiratory rate and days of ventilation were compared in the three groups.ResultsThe rate of total brain injury、non-cerebral hemorrhage and WMD in VLBW and ELBW infants with mechanical ventilation was respectively 71.95%、45.12%(severe IVH 9.76%) and 26.82%; The rate of total brain injury、non-cerebral hemorrhage and WMD in control group was respectively 37.80%、25.61%(severe IVH 2.44%) and 12.20%; The rate of total brain injury、IVH and WMD in VLBW and ELBW infants with mechanical ventilation significantly higher and the degree was more serious than that of control group.In the mechanical ventilation group, there was no significant difference in the highest and lowest values of PaO2、the highest values of PIP, PEEP, respiratory rate and days of ventilation in non-cerebral hemorrhage group、WMD-group and non-injury group. The difference in the highest values of PaCO2 between non-cerebral hemorrhage group and non-injury group were considered statistically significant, and there was also significant difference in the lowest values of PaCO2 between WMD-group and non-injury group.ConclusionThe incidence of brain injury significantly higher than non-mechanical ventilation group in VLBW and ELBW infants; The form of brain damage is in mechanical ventilation infants is still mainly non-cerebral hemorrhage, followed by white matter damage. Hypercapnia. hypocapnia and hypotension generated in mechanical ventilation may induce or aggravate brain injury in VLBW and ELBW infants.更多还原