高频振荡通气治疗新生儿呼吸窘迫综合征临床研究

Clinical analysis of high-frequency oscillatory ventilation in treatment of severe neonatal respiratory distress syndrome

目的探讨高频振荡通气(HFOV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性。方法选择2010年12月-2014年6月在我院新生儿重症监护室(NICU)住院需机械通气治疗的新生儿呼吸窘迫征患儿45例,按通气模式分为HFOV组25例和SIMV组20例,比较2组患儿上机后1 h、12 h和24h的血气指标、上机时间、住院时间、临床疗效及肺气漏(PAL)、支气管肺发育不良(BPD)、脑室内出血(IVH)等并发症的发生率。结果 HFOV组治疗1h后动脉血氧分压(Pa O2)明显上升,动脉血二氧化碳分压(Pa CO2)、氧合指数(OI)明显下降,与SIMV组比较差异有统计学意义(P<0.05);2组治疗开始时、12 h、24 h的Pa O2、Pa CO2、OI比较差异均无统计学意义(P>0.05)。HFOV组上机时间、住院时间短于SIMV组,差异有显著性(P<0.05)。2组PAL、BPD、IVH发生率、治愈率差异均无显著性(P>0.05)。结论 HFOV用于治疗新生儿呼吸窘迫综合征,能迅速改善肺呼吸功能,缩短上机时间及病程,同时并不增加并发症的发生率,是一种疗效肯定、安全性好的机械通气方法。

Objective To evaluate the effects of high frequency oscillatory ventilation （HFOV） in treatment of neonatal respiratory distress syndrome （NRDS）. Methods 45 premature newborns with NRDS were divided into two groups：a research group （ HFOV, 25cases ） and a control group （ SIMV, 20cases ）. Blood gas analysis （ 1 h, 12 h, and 24 h after mechanical ventilation ） , duration of mechanical ventilation and hospitalization, clinical efficacy, and incidence of mechanical ventilation complications were compared between the two groups. Results One hour after giving mechanical ventilation, PaO2 increased and PaCO2 decreased in the research group, and the difference between the two groups was statistically significant （P 〈 0.05 ）. But there was no statistically significant difference of PaO2 ,PaCO2 and OI at the beginning, 12 h, and 24 h of the therapy between the two groups. The mechanical ventilation time and hospitalization in the research group was shorter than in the control group （ P 〈 0.05 ）. There were no significant differences between the two groups in the incidences of PAL, BPD, IVH and survival rates （ P 〉 0.05 ）. Conclusion HFOV can rapidly improve pulmonary respiratory function, decrease the duration of mechanical ventilation and hospitalization. HFOV is an effective and safe mechanical ventilation method for severe NRDS.