高频振荡通气联合多巴酚丁胺应用于新生儿持续性肺动脉高压的临床效果观察

Clinical effect of high frequency oscillatory ventilation combined with dobutamine on persistent pulmonary hypertension in neonates

目的探究高频振荡通气联合多巴酚丁胺应用于新生儿持续性肺动脉高压的临床效果。方法回顾性选取2015年4月至2017年4月东阳市人民医院收治的新生儿持续性肺动脉高患儿62例为研究对象,按照按照病例号单号双号将其分为对照组和试验组,每组纳入31例,试验组采用高频振荡通气联合多巴酚丁胺治疗,对照组采用常频机械通气联合多巴酚丁胺治疗,观察比较两组的治疗效果、血氧饱和度(SpO2)、氧合指数(OI)、C反应蛋白(CRP)、脑钠肽(BNP)、D-二聚体(D-D)、肺动脉压(PAP)、体循环收缩压(SBP)、吸氧时间、呼吸机治疗时间以及并发症发生率。结果试验组患儿的治疗效果(96.77%)比对照组(76.41%)高(χ^2=5.16,P=0.02);试验组SpO2为(93.03±14.06)%,对照组为(82.15±13.87)%,差异有统计学意义(t=3.06,P=0.00);试验组OI为(17.35±1.46),对照组为(57.36±15.36),差异有统计学意义(t=14.43,P=0.00);试验组CRP为(2.62±0.63)mg/L,对照组为(3.69±0.72)mg/L,差异有统计学意义(t=6.22,P=0.00);试验组BNP为(6.19±1.06)ng/L,对照组为(8.34±1.63)ng/L,差异有统计学意义(t=6.15,P=0.00);试验组D-D为(7.62±1.97)mg/L,对照组为(15.72±2.81)mg/L,差异有统计学意义(t=13.14,P=0.00);试验组PAP为(27.65±5.06)mmHg,对照组为(33.52±4.62)mmHg,差异有统计学意义(t=4.76,P=0.00);试验组SBP为(71.62±6.35)mmHg,对照组为(65.22±6.58)mmHg,差异有统计学意义(t=5.29,P=0.00);试验组吸氧时间为(9.96±5.63)d,对照组为(7.21±3.45)d,差异有统计学意义(t=2.23,P=0.02);试验组呼吸机治疗时间为(18.42±5.52)d,对照组为(13.65±4.12)d,差异有统计学意义(t=3.85,P=0.00);试验组并发症发生率(22.58%)较对照组(6.45%)低(χ^2=6.71,P=0.00)。结论采用高频振荡通气联合多巴酚丁胺进行治疗新生儿持续性肺动脉高压效果更好,值得临床推广。

Objective To investigate the clinical effects of high frequency oscillatory ventilation combined with dobutamine in the treatment of neonates with persistent pulmonary hypertension. Methods From April 2015 to April 2017,62 neonates with persistent pulmonary hypertension in the People's Hospital of Dongyang were selected.The patients were divided into control group and experimental group according to the single number,with 31 cases in each group.The experimental group was given high-frequency oscillatory ventilation combined with dobutamine treatment.The control group was treated with constant frequency mechanical ventilation combined with dobutamine.The therapeutic effect,blood gas,analytical indicators,biochemical indicators,pulmonary arterial pressure,systemic systolic blood pressure,oxygen inhalation time,ventilator treatment time,and incidence rate of complication were compared between the two group. Results Compared with the control group (76.41%),the effective rate (96.77%) was increased in the experimental group (χ2=5.16,P=0.02).The SpO2 of the experimental group was (93.03±14.06)%,which was higher than (82.15±13.87)% of the control group (t=3.06;P=0.00).The OI in the experimental group was (17.35±1.46),which was lower than (57.36±15.36) in the control group (t=14.43;P=0.00).The CRP,BNP,DD,PAP levels in the experimental group were (2.62±0.63) mg/L,(6.19±1.06)ng/L,(7.62±1.97)mg/L,(27.65±5.06)mmHg,respectively,which were lower than those in the control group [(3.69±0.72)mg/L,(8.34±1.63)ng/L,(15.72±2.81)mg/L,(33.52±4.62) mmHg](t=6.22,6.15,13.14,4.76;P=0.00,0.00,0.00,0.00).SBP in the experimental group was (71.62±6.35)mmHg,which was higher than (65.22±6.58)mmHg in the control group (t=5.29,P=0.00).The oxygen infusion time,ventilator treatment time of the experimental group were (9.96±5.63)d,(18.42 ± 5.52)d,respectively,which were longer than those in the control group [(7.21 ± 3.45)d,(13.65 ± 4.12)d](t=2.23,3.85,P=0.02,0.00).The incidence rate of complications in the experimental group was 22.58%,which was lower than 6.45% in the control group (χ2=6.71,P=0.00). Conclusion High frequency oscillatory ventilation combined with dobutamine in the treatment of neonatal persistent pulmonary hypertension has better effect and is worthy of clinical promotion.