机械通气治疗新生儿肺出血的临床观察

Clinical observation on mechanical ventilation in treatment of neonatal pulmonary hemorrhage

目的:研究机械通气治疗新生儿肺出血的临床疗效。方法:将23例肺出血新生儿分组采用常频机械通气(CMV)、高频震荡通气(HFOV)呼吸机模式治疗,CMV组(n=13例)采用常频机械通气治疗,HFOV组(n=10例)采用高频震荡通气治疗,比较两组患儿上机后1、4、8、24、48 h的血气和肺氧合功能监测指标以及病情转归。结果:采用机械通气治疗新生儿肺出血总病死率39.1%。HFOV组病死率、并发症发生率低于CMV组(P<0.05),上机后1、4、8、24h的HFOV组低氧血症、高碳酸血症的纠正和肺氧合功能的改善均快于CMV组,两组比较差异有统计学意义(P<0.05);HFOV组平均肺出血停止时间、上呼吸机时间、住院时间均少于CMV组,两组比较差异有统计学意义(P<0.05)。结论:采用机械通气治疗新生儿肺出血有较好的疗效。HFOV能更快纠正低氧血症、高碳酸血症,更好改善肺氧合功能,缩短病程,减少并发症的发生,降低死亡率。

Objective： To study the clinical curative effect of mechanical ventilation in treatment of neonatal pulmonary hemorrhage. Methods： Twenty- three neonates with pulmonary hemorrhage were divided into conventional mechanical ventilation （CMV） group and high frequency oscillatory ventilation （HFOV） group, thirteen neonates in CMV group were treated with CMV therapy, while ten neonates in HFOV group were treated with HFOV therapy. Blood gas analysis, monitoring indexes of pulmonary oxygenation, and prognosis of the disease at 1,4, 8, 24, and 48 hours after mechanical ventilation in the two groups were compared. Results ： The total fatality rate of neonates with pulmonary hemorrhage treated with mechanical ventilation was 39.1%. The fatality rate and the incidence of complications in HFOV group were significantly lower than those in CMV group （P 〈 0. 05 ） . At 1,4, 8, and 24 hours after mechanical ventilation, the cor- rection of hypoxemia and hypercapnia, the improvement of pulmonary oxygenation in HFOV group were significantly quicker that those in CMV group （P 〈 0. 05） . The mean stopping time of pulmonary hemorrhage, the main application time of mechanical ventilation, and the mean hospitalization time in HFOV group were significantly shorter than those in CMV group （ P 〈 0. 05 ） . Conclusion ： The curative effect of mechanical ventilation is good in treatment of pulmonary hemorrhage. HFOV can correct hypoxemia and hypercapnia more quickly, im- prove pulmonary oxygenation, shorten the course of the disease, and reduce the occurrence of complications and neonatal mortality.