常频和高频机械通气治疗新生儿呼吸窘迫综合征的临床研究

Conventional mechanical ventilation and high-frequency oscillatory ventilation in treatment of neonatal respiratory distress syndrome

目的 评价肺保护通气策略的常频和高频机械通气治疗早产儿呼吸窘迫综合征（NRDS）的疗效及安全性。方法 56例行机械通气的NRDS早产儿，分为常频机械通气（CMV）组和高频机械通气（HFOV）组，记录两组的血气和呼吸机参数的变化情况，观察两组的临床疗效及慢性肺疾病（CLD）、肺气漏（PAL）、Ⅲ-Ⅳ级颅内出血（IVH）、脑室周围白质软化（PVL）等并发症的发生率。结果 HFOV组患儿氧合迅速改善，24h内吸入氧浓度、氧合指数、平均气道压下降明显，差异具有显著性（F=4．23、5．09、4．37，P均〈0．05）。24h时HFOV组吸入氧浓度与CMV组比较，差异有显著性（t=2．181．P〈0．05）。CMV组治愈27例，死亡3例；HFOV组治愈24例，死亡2例，两组比较差异无显著性（Y2=0．091，P〉0．05）。CMV组并发CLD1例、PAL2例、Ⅳ级IVH2例、PVL1例；HFOV组并发CLD、PAL、Ⅲ级IVH、Ⅳ级IVH、PVL各1例。两组CLD、PAL、IVH、PVL发生率比较差异均无显著性（χ^2=0．015、0．015、0．241、0．007，P均〉0．05）。CMV组机械通气时间（86．5±20．5）h，HFOV组（60．5±16．5）h，两组比较差异有非常显著性（t=2．641，P〈0．01）。CMV组住院时间（34．5±8．5）d，HFOV组（28．5±6．5）d，两组比较差异有显著性（t=2．015，P〈0．05）。结论 肺保护通气策略的CMV和HFOV治疗NRDS是有效和安全的，HFOV能迅速改善氧合，缩短上机和住院时间。

Objective To evaluate the efficacy and safety of conventional mechanical ventilation （CMV） with lung protect ventilation strategies and high-frequency oscillatory ventilation（HFOV） for treatment of neonatal respiratory distress syndrome（NRDS）. Methods Fifty-six preterm infants with NRDS were enrolled in the study and allocated to either CMV（ n = 30） or HFOV（ n = 26）. Blood gas values, respiratory parameters, clinical efficacy, and incidence of mechanical ventilation complications were compared between two groups. Results Within 24 h of treatment, HFOV resulted in greater improvement in FiO2, MAP, OI than CMV. During the first 24 h of treatment, FiO2 was lower in HFOV group than that in CMV group. There were 27 survivaled, 3 died in CMV group, and 24 survivaled, 2 died in HFOV group. No significant differences were found between the two groups in mortality（P 〉 0.05）. There were no significant differences between the two groups in the incidences of chronic lung disease, pulmonary air leakage, and serious brain injury（ P 〉 0.05）. The ventilation time and hospitalization time were （86.5± 20.5） h, （34.5 ± 8.5） d in CMV group, which were significantly longer than that in HFOV group [ （60.5 ± 16.5） h, （28.5± 6.5 ） d ] （ P 〈 0.01, P 〈 0.05 ）. Conclusion It is efficient and safe for treatment of NRDS with CMV and HFOV using lung protective ventilation strategies. HFOV can rapidly improve oxygenation, decrease ventilation time and hospitalization time.