新生儿呼吸窘迫综合征无创高频振荡通气治疗临床观察

Clinical observation of noninvasive high frequency oscillatory ventilation in the treatment of neonatal respiratory distress syndrome

目的探讨无创高频振荡通气在新生儿呼吸窘迫综合征(NRDS)初始治疗中的临床疗效。方法选取2019-01-04-2020-10-20河南科技大学第一附属医院收治的97例NRDS患儿为研究对象。按照组间性别、胎龄、出生体质量等资料具有可比性的方法分为对照组(48例)和观察组(49例)。对照组采用经鼻持续气道正压通气治疗,观察组采用无创高频振荡通气治疗。比较对照组和观察组患儿治疗前后血气指标和肺功能变化,治疗后呼吸暂停症状消失时间、住院时间及呼吸暂停发作情况。结果治疗前,对照组和观察组患儿二氧化碳分压(PaCO_(2))分别为(56.16±5.34)和(56.69±5.58)mm Hg、动脉血氧分压(PaO_(2))分别为(56.44±4.34)和(55.75±4.51)mm Hg,氧合指数[PaO_(2)/氧浓度分数(FiO_(2))]分别为(188.75±16.54)和(186.96±15.77)mm Hg,左室射血分数(LVEF)分别为(38.79±6.28)%和(38.16±5.97)%,肺动脉压力(PAP)分别为(61.02±5.47)和(61.73±5.92)mm Hg,差异无统计学意义,均P>0.05。治疗后,观察组PaCO_(2)为(39.54±5.23)mm Hg,低于对照组的(45.25±5.41)mm Hg,t=5.285,P<0.05;PAP为(36.26±5.02)mm Hg,低于对照组的(40.34±4.85)mm Hg,t=3.206,P<0.05;PaO_(2)为(82.01±5.24)mm Hg,高于对照组的(75.74±4.79)mm Hg,t=17.910,P<0.05;PaO_(2)/FiO_(2)为(317.45±16.83)mm Hg,高于对照组的(255.69±17.13)mm Hg,t=4.283,P<0.05;LVEF为(65.51±6.27)%,高于对照组的(60.23±5.86)%,t=4.070,P<0.05。观察组治疗后呼吸暂停症状消失时间为(29.45±3.14)h,早于对照组的(50.78±5.52)h,t=23.450,P<0.05;住院时间为(11.85±2.04)d,短于对照组的(13.78±2.11)d,t=4.580,P<0.05;呼吸暂停发作率为16.67%,低于对照组的36.73%,χ^(2)=4.977,P<0.05。结论高频振荡通气治疗可明显提高NRDS患儿血气指标及心肺功能,改善呼吸暂停症状,缩短住院治疗时间,临床疗效满意。

Objective To investigate the clinical effect of high frequency oscillatory ventilation in the initial treatment of neonatal respiratory distress syndrome(NRDS).Methods Totally 97 children with NRDS admitted to our hospital from January 4,2019 to October 20,2020 were selected as the research objects.They were randomly divided into control group(48 cases)and observation group(49 cases).The control group was treated with nasal continuous positive airway pressure,and the observation group was treated with noninvasive high frequency oscillatory ventilation.The changes of blood gas index and pulmonary function,the disappearance time of apnea symptoms,hospital stay and apnea attack were compared between the two groups before and after treatment.Results Before treatment,partial pressure of carbon dioxide(PaCO_(2))were(56.16±5.34)and(56.69±5.58)mm Hg,arterial partial pressure of oxygen(PaO_(2))were(56.44±4.34)and(55.75±4.51)mm Hg,PaO_(2)/fractional concentration of inspired oxygen(FiO_(2))were(188.75±16.54)and(186.96±15.77)mm Hg,left ventricular ejection fraction(LVEF)were(38.79±6.28)%and(38.16±5.97)%,pulmonary artery pressure(PAP)were(61.02±5.47)and(61.73±5.92)mm Hg,respectively,and the difference was not statistically significant between two groups(all P>0.05).After treatment,PaCO_(2)in the observation group was(39.54±5.23)mm Hg,lower than that in the control group(45.25±5.41)mm Hg,t=5.285,P<0.05.PAP of(36.26±5.02)mm Hg was lower than that of the control group(40.34±4.85)mm Hg,t=3.206,P<0.05.PaO_(2)was(82.01±5.24)mm Hg,higher than that of the control group(75.74±4.79)mm Hg,t=17.910,P<0.05.PaO_(2)/FiO_(2)was(317.45±16.83)mm Hg,higher than that of the control group(255.69±17.13)mm Hg,t=4.283,P<0.05.LVEF was(65.51±6.27)%,higher than that of control group(60.23±5.86)%,t=4.070,P<0.05.The disappearance time of apnea in the observation group after treatment was(29.45±3.14)h,which was earlier than that in the control group(50.78±5.52)h,t=23.450,P<0.05.The length of hospital stay(11.85±2.04)d was shorter than that of the control group(13.78±2.11)d,t=4.580,P<0.05.The incidence of apnea was 16.67%,lower than that of control group(36.73%),χ^(2)=4.977,P<0.05.Conclusion High frequency oscillation ventilation can significantly improve the blood gas index and cardiopulmonary function in children with NRDS,improve the symptoms of apnea,shorten the hospitalization time,and the clinical effect is satisfactory.