高频振荡通气在新生儿气胸治疗中的临床观察

Clinical application of high-frequency oscillatory ventilation for the treatment of neonatal pneumothorax

目的探讨高频振荡通气(HFOV)在新生儿气胸治疗中的疗效。方法回顾性分析2007年1月至2011年6月接受HFOV治疗的23例新生儿气胸患儿的临床资料(HFOV组),其中19例明确诊断后立即应用HFOV治疗,另4例因常频通气或持续气道正压通气治疗中出现气胸后改为HFOV。选取同期23例接受常频通气治疗的新生儿气胸患儿作为对照组。比较两组上机前、上机后1 h、12 h、24 h、48 h氧合指数(OI)、动脉/肺泡氧分压(a/APO2)以及上机时间、气胸吸收时间、合并症及转归。结果两组呼吸机治疗后与上机前比较OI明显降低,a/APO2明显升高(P<0.05)。HFOV组上机后1 h、12 h、24 h、48 h OI低于对照组,a/APO2高于对照组,(P<0.05)。HFOV组上机时间、气胸吸收时间较对照组明显缩短(P<0.05)。HFOV组治愈22例,对照组治愈21例。两组各出现呼吸机相关性肺炎1例,均在使用抗生素后治愈。结论 HFOV能更好地改善新生儿气胸患儿的氧合功能,缩短上机和气胸吸收时间,较常频通气治疗患儿并不增加不良反应的发生率。

Objective To evaluate the clinical effect of high-frequency oscillatory ventilation （HFOV） for the treatment of neonatal pneumothorax. Methods Retrospective analysis was performed on the clinical data of 23 neonates with pneumothorax who received HFOV from January 2007 to June 2011. Of the 23 cases, 19 cases were treated by HFOV as soon as they were diagnosed with pneumothorax, and 4 cases were treated by HFOV after the occurrence of pneumothorax during conventional mechanical ventilation （CMV） or continuous positive airway pressure （CPAP） ventilation. Another 23 neonates with pneumothorax who received CMV in the same period were selected as controls. The HFOV group and control group were compared with respect to oxygenation index （OI） and arterial/alveolar oxygen tension ratio （a/APO2 ） before and after 1, 12, 24, and 48 hours of ventilation as well as mechanical ventilation time, gas absorption time ,complication, and prognosis. Results Both groups showed significantly decreased OI and significantly increased a/APO2 after ventilation （ P 〈 0.05 ）. Compared with the control group, the HFOV group had significantly lower OI and significantly higher a/APO2 after 1, 12, 24, and 48 hours of ventilation （ P 〈 0.05 ）. Mechanical ventilation and gas absorption times were significantly shorter in the HFOV group than in the control group （P 〈 0.05 ）. Twenty-two cases were cured in the HFOV group and 21 in the control group. Each group included one case of ventilator-associated pneumonia that was later cured with antibiotics. Conclusions Compared with CMV, HFOV performs better in improving the pulmonary oxygenation function of neonates with pneumothorax and can shorten both mechanical ventilation time and gas absorption time without increasing the incidence of adverse effects.