Hemodynamic Changes Of Neonatal Respiratory Distress Syndrome Before And After Mechanical Ventilation

Objective: The hemodynamic changes of neonatal respiratory distress syndrome before and after mechanical ventilation were monitored by non-invasive hemodynamics,and the effects of mechanical ventilation on hemodynamics of NRDS were discussed..Method: From February 2018 to December 2018,136 children with neonatal respiratory distress syndrome diagnosed and treated with invasive mechanical ventilation in our hospital met the inclusion criteria.A total of 114 children were included in the study after exclusion.They were divided into three groups according to their gestational age:(GA)< 28 weeks in 12 cases(M 9? F 3),28 weeks ? GA ? 32 weeks in 48 cases(M 29?F 19),and GA<37W in 54 cases(M 30?F 24).Each child met the standard of withdrawal and was prepared to pull out the trachea catheter and change it into noninvasive ventilator assisted ventilation 1 hour before noninvasive cardiac system monitor was used to continuously monitor the hemodynamics of the children.The parameters of ventilator before withdrawal(synchronous intermittent instruction ventilation mode: peak inspiratory pressure,positive end-breath pressure,respiratory frequency,inhaled oxygen concentration,N-CPAP parameters after withdrawal(Fi O2 ? PEEP)were recorded.The stable hemodynamic values of the children before and after withdrawal were heart rate,output per wave,cardiac index,cardiac work index,Granff-Gore index and peripheral vascular resistance index.Result:3.1 Basic Information:3.1.1 A total of 114 premature infants were divided into three groups according to gestational age,including 12 cases of GA<28W,48 cases of 28W? GA ? 32 W,and 54 cases of 32 W < GA < 37 W.There was no significant difference in sex,sodium and hematocrit among the three groups(P>0.05).There was a significant difference in body length and body weight among the three groups(P<0.05).There were significant differences in mechanical ventilation time,systolic blood pressure,diastolic blood pressure and mean blood pressure among the three groups(P<0.05).3.1.2 Parameters of ventilator(SIMV mode)before ventilator withdrawal:there was no significant difference in PEEP?Fi O2 among the three groups before withdrawal.(P> 0.05).There was significant difference in PIP among the three groups before withdrawal(P< 0.05).3.1.3 Parameters of N-CPAP after withdrawal: After weaning,There was no significant difference in the PEEP of different gestational age N-CPAP model(P>0.05).32 W <GA<37W,28W?GA?32W compared with GA < 28 W,the difference of Fi O2 after weaning was statistically significant(P < 0.05).3.2 There was significant difference in HR in children of the same gestational age before and after withdrawal(P<0.05).The HR of children after withdrawal was lower than that before withdrawal,and there was significant difference in HR among the three groups of children of different gestational ages(P<0.05).With the increase of gestational age,HR tends to slow down.3.3 There was significant difference in SV in children of the same gestational age before and after withdrawal.(P<0.05),The SV after withdrawal was higher than that before withdrawal,and there was significant difference in SV among the three groups of children of different gestational ages(P< 0.05).With the increase of gestational age,SV tends to increase.(P<0.05).3.4 There was significant difference in CI in children of the same gestational age before and after withdrawal(P < 0.05).The CI after withdrawal was higher than that before withdrawal,and there was significant difference in CI among the three groups before withdrawal(P<0.05).There was no significant difference in CI between GA<37W and 28W< GA <32W after weaning(P>0.05).3.5 There was no significant difference in GGI in children of the same gestational age before and after withdrawal(P > 0.05).With the increase of gestational age,GGI gradually increased.3.6 There was no significant difference in cardiac work index(CPI)before and after weaning in children of the same gestational age(P>0.05).With the increase of gestational age,there was an increasing trend of CPI.3.7 There was a significant difference in systemic peripheral vascular resistance index(TPRI)before and after weaning in children of the same gestational age(P < 0.05),The TPRI after weaning is smaller than that before weaning.There was a significant difference in TPRI among three groups of children of different gestational age(P <0.05).With the increase of gestational age,TPRI tended to decrease.Conclusion: 1?Compared with the hemodynamic changes of invasive ventilator-assisted ventilation and non-invasive assisted ventilation in children with NRDS,It was found that mechanical ventilation had an effect on the HR?SV?CI of children.After evacuating the invasive ventilator,the HR slowed down and the SV?CI increased.2?There was no significant difference in CPI?GGI before and after withdrawal of NRDS,which proved that the withdrawal of invasive ventilator had no significant effect on the contractile ability of the heart of the children,and CPI?GGI tended to increase with the increase of gestational age.It is proved that the higher the maturity of the child,the stronger the cardiac function and cardiac reserve ability.3 ? Children with NRDS who need invasive mechanical ventilation should pay attention to the effect of ventilator parameters on cardiac function and circulatory system,and the high pressure of ventilator parameters has an effect on hemodynamics.When the pulmonary condition of children with NDRS is improved,there are signs of withdrawal and stable hemodynamics,and the trachea catheter can be pulled out as soon as possible to change into noninvasive auxiliary ventilation,which is beneficial to the stability of hemodynamics in children.