高频通气治疗新生儿胎粪吸入综合征所致呼吸衰竭价值探讨

Value of high frequency oscillatory ventilation therapy for respiratory failure induced by neonatal meconium aspiration syndrome

目的比较高频振荡通气与常频通气在新生儿胎粪吸入综合征(MAS)所致呼吸衰竭治疗中的效果。方法回顾性复习新生儿重症监护室收治MAS所致呼吸衰竭患儿58例。A组为高频振荡通气组(HFOV,n=28),B组同步间歇指令机械通气+容量目标组(SIMV+VG,n=30),比较两组治疗前后各时点(0 h、6 h、24 h、48 h)氧合指数(OI)、动脉/肺泡氧分压比值(a/APO2)的变化、治疗过程中并发症(肺气漏、BPD、脑出血)发生率及病死率;同时比较两组患儿氧暴露及机械通气时间。结果在机械通气6 h、24 h及48 h时间位点,两组OI和a/APO2比较差异无统计学意义(P>0.05),与同组0 h相比,差异均有统计学意义(P<0.05);HFOV组肺气漏、BPD、脑出血发生率、病死率、氧暴露及机械通气时间与SIMV+VG组相比,差异无统计学意义(P>0.05)。结论与SIMV+VG机械通气模式相比,HFOV治疗新生儿胎粪吸入综合征所致呼吸衰竭疗效无明显差异,患儿未能获益。

Objective To study the value of high frepuency oscillatory ventilation therapy for respiratory failure induced by neonatal meconium aspiration syndrome （MAS） by comparing with conventional mechanical ventilation. Methods Fifty-eight neonates with respiratory failure induced by MAS admitted consecutively to Neonatal Intensive Care Unit （NICU） were respectively studied.They were assigned into Group A （HFOV, n = 28） and Group B（SIMV＋VG, n = 30）, OI and a/APO： were monitored at 0 h,6 h,24 h,48 h after mechanical ventilation, incidences of lung air leak, broncho-pulmonary dysplasia （BPD）, intraventicular hemorrhage （IVH）, mortality and ventilation time, oxygen exposure time were compared. Results There were no differences in OI and a/APO2 at 6 h, 24 h and 48 h after ventilation between the two groups （P 〉 0.05） ;but compared with 0 h, OI and a/APO2at 6 h, 24 h and 48 h all had difference （P〈 0.05）. At the same time, compared with the SIMV＋VG group, the HFOV group showed similar incidences of lung air leak, BPD, IVH and mortality （P 〉 0.05）, and had not shorten the ventilation time, oxygen exposure time （P 〉 0.05）. Conclusion The efficacy of HFOV therapy for respiratory failure induced by neonatal MAS appears to be similar to SIMV＋VG therapy, suggesting that HFOV therapy fails to be beneficial for MAS.