不同机械通气方式联合牛肺表面活性剂对呼吸衰竭新生儿呼吸力学的影响

The effects of different mechanical ventilation combined with calf pulmonary surfactant on the respiratory mechanics in neonates with respiratory failure

目的:探讨不同机械通气方式联合牛肺表面活性剂对呼吸衰竭(RF)新生儿呼吸力学的影响。方法:选取2015-03—2018-03期间本院收治的RF新生儿100例,依据随机数字表法分为高振组和常振组,每组50例,常振组给予常频振荡机械通气联合牛肺表面活性剂治疗,高振组给予高频振荡机械通气联合牛肺表面活性剂治疗,比较两组呼吸力学[呼吸系统动态顺应性(C)、肺膨胀系数(C20/C)、每分通气量(MV)、呼吸道阻力(R)、平均气道压(MAP)]、血气氧合[动脉血氧分压(PaO2)、氧合指数(OI)、二氧化碳分压(PaCO2)]、并发症、死亡、身体康复情况。结果:高振组和常振组治疗6、12、24h后C、C20/C、MV、PaO2、OI明显高于治疗前,高振组和常振组治疗6、12、24h后R、MAP、PaCO2明显低于治疗前,高振组治疗6、12、24h后C、C20/C、MV、PaO2、OI明显高于常振组,高振组治疗6、12、24h后R、MAP、PaCO2明显低于常振组,差异有统计学意义(P<0.05);高振组机械通气、开奶、住院时间和并发症率明显低于常振组,差异有统计学意义(P<0.05),高振组病死率低于常振组,但差异无统计学意义(P>0.05)。结论:与常频振荡比较,高频振荡机械通气联合牛肺表面活性剂可有效改善RF新生儿呼吸力学,有利于改善新生儿疗效及预后水平,值得临床作进一步推广。

Objective:To discuss the effects of different mechanical ventilation combined with calf pulmonary surfactant on the respiratory mechanics in neonates with respiratory failure(RF).Method:One hundred neonates with respiratory failure(RF)were selected from March 2015 to March 2018 in our Hospital,according to the random digital table method,and they were divided into high vibration group and conventional vibration group(50 cases in each group).The conventional vibration group was given conventional oscillatory mechanical ventilation combined with calf pulmonary surfactant treatment,high vibration group was given high frequency oscillatory mechanical ventilation combined with calf pulmonary surfactant treatment,the respiratory mechanics[respiratory system dynamic compliance(C),lung expansion coefficient(C20/C),per minute ventilation)were compared.Volume(MV),respiratory resistance(R),mean airway pressure(MAP)],oxygenation of blood gas[(PaO2),oxygen index(OI),carbon dioxide partial pressure(PaCO2)],complications,death,physical rehabilitation were compared in two groups.Result:The 6,12,24 hC,C20/C,MV,PaO2,OI after treatment in the high vibration group and the conventional vibration group were significantly higher than those in the before treatment,the 6,12,24 hR,MAP,PaCO2 after the treatment in the high vibration group and the conventional vibration group were significantly lower than those in the before treatment,the 6,12,24 hC,C20/C,MV,PaO2,OI after treatment in the high vibration group were significantly higher than those in the conventional vibration group,the 6,12,24 hR,MAP,PaCO2 after the treatment in the high vibration group were significantly lower than those in the conventional vibration group,the difference was statistically significant(P<0.05).The mechanical ventilation,milk opening,hospitalization time and complication rate in the high vibration group were significantly lower than those in the conventional vibration group,the difference was statistically significant(P<0.05),the mortality rate in the high vibration group was lower than that in the conventional vibration group,but the difference was not statistically significant(P>0.05).Conclusion:Compared with conventional oscillation,high frequency oscillatory mechanical ventilation combined with calf pulmonary surfactant can effectively improves the respiratory mechanics of neonates with RF,which is helpful to improve the curative effect and prognosis of neonates,it’s worth for further clinical promotion.