高频振荡通气对严重呼吸窘迫综合征早产儿预后的影响

Effects of high-frequency oscillatory ventilation on preterm infants with severe respiratory distresssyndrome

目的探讨高频振荡通气对严重呼吸窘迫综合征早产儿临床预后及脑神经发育的影响。方法109例出生体质量〈1500g，严重呼吸窘迫综合征早产儿，随机分为治疗组（高频振荡通气组，HFOV）与对照组（常频机械通气组，CMV），应用呼吸机后2h，动脉氧分压（PaO2）／吸入氧浓度（FiO2）比值〈200，临床给予肺表面活性物质的应用（固尔苏100—200mg／kg）。主要观测肺表面活性物质应用、支气管肺发育不良、气胸、颅内出血及病死率，在18个月龄时对存活者进行神经发育评估。结果109例研究对象中有5例在治疗中放弃，7例死亡，30例失访，79例患儿在18个月龄时相关资料齐全。住院治疗期间，HFOV组的肺表面活性物质的应用、气胸、支气管肺发育不良、颅内出血、病死率均低于CMV组，差异有统计学意义（P〈0．05）。随访脑瘫、耳聋、失明的发生率两者比较差异无统计学意义（P〉0．05）；MDI〈70发生率，HFOV组低于CMV组，两组比较差异有统计学意义（P〈0．05）。结论高频振荡通气能改善严重呼吸窘迫综合征早产儿临床预后，无严重并发症的发生。

Objective To investigate the effect of high-frequency oscillatory ventilation on pre- term infants with severe respiratory distress syndrome and to evaluate the neurodevelopment. Methods One hundred and nine preterm infants with birth weight less than 1500 g, and severe respiratory distress syndrome, were randomly divided into treatment group of high-frequency oscillatory ventilation （HFOV） and the control group of conventional mechanical ventilation （CMV） , after application of ventilator for 2hours, arterial oxygen pressure （PaO2 ） / inspired oxygen （ FiO2 ） ratio 〈 200, the pulmonary surfactant （ Curosurf 100 - 200 mg/kg） was given. The primary outcomes were surfactant applications, pneumothorax, bronchopulmonary dysplasia, intracranial hemorrhage and mortality were observed, the neural development was evaluated at 18th month for the survivors. Results Among the 109 patients studied, 5 cases abandoned the treat- ment, 7 cases died, 30 cases were lost, and 79 cases had relevant information when they were 18 months of age. During hospitalization, the application of pulmonary surfactant, pneumothorax, bronchopulmonary dysplasia, intracranial hemorrhage and mortality in HFOV group were lower than those in CMV group, there were significant differences （P 〈 0. 05 ）. There was no significant difference in cerebral palsy, deafness or blindness between the two groups （P 〉 0. 05 ） ; There was significant difference in the inci- dence of MDI 〈 70, HFOV group was less than CMV group. Conclusions High frequency oscillatory ventilation can improve the prognosis of severe respiratory distress preterm children, and without serious complication.