高频振荡通气治疗新生儿呼吸窘迫综合征临床效果观察

Clinical effect of high frequency oscillatory ventilation for treatment of neonatal respiratory distress syndrome.

目的探讨新生儿呼吸窘迫综合征(NRDS)采用高频震荡通气治疗的临床疗效。方法选取我院2013年1月至2014年1月收治的87例需要进行机械通气治疗的NRDS患儿,采用随机数表法分为观察组(44例)和对照组(43例),观察组患儿采用高频振荡通气治疗,对照组采用常频机械通气治疗,比较两组治疗不同时间的血气分析及氧合参数变化情况、上机时间、住院时间及并发症差异。结果治疗开始时(0 h)两组患儿的吸入氧浓度(FiO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(OI)指数比较差异均无统计学意义(P>0.05);治疗后1 h、6 h、12 h、24 h,观察组患儿的PaO2值显著高于对照组,差异具有统计学意义(P<0.05),观察组的PaCO2、FiO2、OI指数值均明显低于对照组,差异均具有统计学意义(P<0.05);治疗后1 h、6 h、12 h、24 h,观察组和对照组患儿的PaO2、PaCO2、FiO2、OI指数值与0 h时刻比较差异均具有统计学意义(P<0.05);观察组患儿的上机时间和住院时间分别为(5.4±0.8)d、(29.8±5.4)d,明显低于对照组,差异具有统计学意义(P<0.05),观察组患儿的死亡率为18.18%,低于对照组的25.58%,但差异无统计学意义(P>0.05);两组患儿的主要并发症为新生儿硬肿症、其次是肺炎,两组患儿各种并发症发生率比较差异均无统计学意义(P>0.05)。结论高频震荡通气治疗新生儿呼吸窘迫综合征较常频机械通气治疗能够显著的改善患者的血气指标、氧合指数,可以显著的缩短住院及机械通气治疗时间。

Objective To discuss the clinical efficacy of high frequency oscillation ventilation in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods Eighty-seven patients of NRDS in our hospital from January 2013 to January 2014 who scheduled for mechanical ventilation were divided into the observation group（44 cases） and control group（43 cases）. The observation group was treated by high frequency oscillation ventilation,and the control group applied conventional mechanical ventilation therapy. Blood gas analysis, changes in oxygenation parameters, ventilation time, length of hospital stay, and complications were compared between the two groups.Results At the start of treatment（0 h）, the two groups showed no statistically significant difference in FiO2, PaO2, PaCO2, oxygenation index（OI）, P〉0.05. 1 h, 6 h, 12 h, 24 h after treatment, the PaO2 values in the observation group were significantly higher than those in the control group（P〈0.05）, and Pa CO2, FiO2,OI index values in the observation group were significantly lower（P〈0.05）. Values of PaO2, Pa CO2, FiO2,OI index in the two groups 1 h, 6 h, 12 h, 24 h after treatment showed statistically significant differences compared with those at the start of treatment（0 h）, P〈0.05. The ventilation time and length of hospital stay in the observation group were（5.4±0.8） d and（29.8±5.4） d, significantly lower than those in the control group（P〉0.05）. The observation group showed a mortality rate of 18.18%, which was slightly lower than 25.58% in the control group, but the difference was not statistically significant（P〈0.05）. The main complications in two groups were neonatal scleredema, followed by pneumonia, with no statistically significant difference between the two groups（P〉0.05）. Conclusion Compared with conventional mechanical ventilation therapy, high-frequency oscillatory ventilation in the treatment of neonatal respiratory distress syndrome can significantly improve the patient＇s blood gas, oxygenation index, and can significantly shorten the length of hospital stay and mechanical ventilation.