高频震荡通气治疗新生儿气漏并呼吸衰竭的效果

EFFECT OF HIGH FREQUENCY OSCILLATORY VENTILATION IN THE TREATMENT OF NEONATES WITH AIRLEAK AND RESPIRATORY FAILURE

目的 探讨高频震荡通气（HFO）治疗新生儿气漏并呼吸衰竭的效果。方法 重症气漏并呼吸衰竭新生儿38例，15例常频通气（CMV）治疗，23例高频震荡通气（HFO）治疗，观察HFO组治疗前后吸人氧浓度（FiO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）及氧合指数（OI）的变化及临床疗效，并与CMV组机械通气时间、住院天数及医疗费用进行比较。结果 HFO组病情均于24h内明显改善，短时间内气漏消失，无1例行胸腔穿刺或闭式引流；FiO2、PaO2、PaCO2及OI与治疗前比较差异有显著性（F=68．872～362．767，q=5．451～36．262，P〈0．01）；HFO组治疗后12、24h的FiO2及OI值与治疗1、2h时比较，差异均有极显著意义（q=4．859～29．982，P〈0．01）。HFO组机械通气时间、住院天数和医疗费用等优于CMV组，差异有显著意义（t=6．770～11．181，P〈0．01）。结论 HFO治疗新生儿严重气漏并呼吸衰竭的疗效显著，副作用少。

Objective To evaluate the efficacy and safety of high frequency oscillatory ventilation （HFOV） for neonates with airleak and respiratory failure （RF）. Methods Thirty eight infants with severe airleak and RF were enrolled, of whom, 15 were treated with CMV and 23 with HFOV. The FiO2, PaO2, PaCO2 and OI, before and after treatment of HFOV or CMV, were observed, and clinical effects, ventilation time, hospital stay and cost spent were compared. Results The patients＇ condition in HFOV group significantly improved within 24 hours, and airleak disappeared in short time without thoracentesis or closed drainage. Compared with before therapy, the difference was significant after treatment in terms of FiO2, PaO2, PaCO2, and OI （F= 68. 872-362. 767;q=5.451-36.262;P〈0.01）. In HFOV group, the differences between the value of FiO2, OI after 12- and 24- hour therapy and 1- and 2 hour therapy were significant （q=4. 859-29. 982,P〈0.01）. The HFOV was superior to CMV in terms of mechanical-ventilation time, hospital stay and medical cost （t=6. 770-11. 181 ,P〈0.01）. Conclusion HFOV is notably effective and less side-effect in the treatment of neonate with severe airleak and respiratory failure.