序贯机械通气疗法治疗新生儿呼吸窘迫综合征的临床观察

Clinical observation of sequential mechanical ventilation in neonatal respiratory distress syndrome

目的:观察序贯机械通气疗法治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法:将64例严重的NRDS分成两组,治疗组:23例,先应用常规呼吸机(CMV)治疗,通气改善后尽早拔管撤机改用新型鼻塞持续气道正压通气(NCPAP)过渡至自主呼吸的序贯机械通气疗法;对照组:41例,应用CMV通气至撤机,直接过渡至自主呼吸;比较两组的疗效。结果:治疗组和对照组机械通气前的临床基础条件无统计学差异(P>0·05);CMV时间(41·64±9·84)h和(123·76±9·02)h;总通气时间(66·48±10·20)h和(123·76±9·02)h;住院天数(19·04±3·97)d和(29·49±6·27)d;呼吸机相关性肺炎(VAP)例数3例和19例(以上P均<0·01);再插管例数2例和15例(P<0·05);在统计学上均有显著差异。结论:应用序贯机械通气疗法治疗严重的NRDS能有效缩短机械通气时间、住院时间,减少VAP和再插管的风险。

Objective： To observe the efficacy of sequential mechanical ventilation on neonatal respiratory distress syndrome （NRDS） . Methods： 64 cases of severe NRDS were divided into two groups： study group： 23 cases, treated with convention mechanical ventilation （ CMV）, but early extubation was conducted and followed by CMV via nasal continuous positive airway pressure （NCPAP） while the evidences showing improvement in ventilation, and then transmitted to independent breathing, control group： 41 cases, which were continuously received CMV, and then transmitted to independent breathing directly. Results： No statistical difference in clinical initial conditions between study group and control group （all P 〉 0. 05） . The statistical significance appeared in the elapsed time of CMV were （41.64 ±9.84） vs. （123.76±9.02） hours, P〈0.01; total duration of MV were （66.48±10.20） vs. （123.76±9.02） hours, P〈0.01; hospitalization days were （ 19.04 ± 3. 970） vs. （29. 49 ± 6. 27） days, P 〈 0. 01 ; cases of mechanical ventilation associated pneumonia were 3 vs. 19, P 〈0. 01 ; cases of reintubation were 2 vs. 15, P 〈0. 05 respectively. Conclusion： In severe NRDS patients, application of sequential mechanical ventilation can effectively reduce the duration of ventilation, hospitalization days, and the risk of VAP and reintubation.