高频振荡通气治疗早产儿呼吸窘迫综合征及随访分析

High frequency oscillation ventilation treats respiratory distress syndrome of premature

目的 探讨高频振荡通气（HFOV）在早产儿呼吸窘迫综合征（RDS）的应用价值.方法 收集本院新生儿重症监护病房（ICU）需要机械通气的早产儿呼吸窘迫综合征101例,其中高频通气41例（HFOV组）,常频通气（CMV）60例CMV组,比较两组患儿通气前、通气2、12、24h的血气分析差异,并且观察患儿胸片的变化及并发症等发生率.结果 两组患儿通气前血气分析比较差异无统计学意义（P＞0.05）,但两组患儿通气后2、12、24h血气分析中氧浓度（FiO2）、氧分压（PO2）、二氧化碳分压（PCO2）及肺泡-动脉氧分压差[Pa（A-a）]比较,其差异均有统计学意义（F=16.20、14.76、16.14、8.43,P＜0.01）;两组患儿通气24 h及72 h后,其中HFOV组患儿复查胸片明显好转率显著高于对照组（x2=15.37,5.83,P＜0.01或P＜0.05）;两组脑损伤、听力损伤及早产儿视网膜病变（ROP）比较差异均无统计学意义（P＞0.05）.101例患儿中68例随访至24月龄,其中HFOV组21例,CMV组47例,两组患儿体重、身高、头围及神经发育损害（NDI）比较差异均无统计学意义（P＞0.05）.结论 高频振荡通气是治疗早产儿呼吸窘迫综合征的有效方法,不增加早产儿脑室内出血及NDI的风险.提示HFOV不是早产儿发生NDI的高危因素.

Objective To explore the application of high frequency oscillation in the area of respiratory distress syndrome （RDS） of premature.Methods A total of 101 cases with RDS of premature was collected who needed the machine support in neonatal intensive care unite （NICU） during 2010.11.01-2011.10.30.Forty one cases （high frequency oscillation group） received the high frequency oscillation,while 60 cases received the common ventilation （Control Mechanical Ventilation group;control group）.The results of blood gas analysis were recorded before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours.The chest X-Ray and the complication were examined.Results The result of the blood-gas before ventilation,after ventilation for 2 hours,after ventilation for 12 hours,and after ventilation for 24 hours,FIO2,PO2,PCO2,and Pa（A-a） were statistically analyzed,and F-value was 16.202,14.764,16.135,8.434,P 〈 0.01.For chest X-ray in high frequent oscillation group,there were 36 cases who had improved after ventilation 24 hours and all had improved after ventilation 72 hours;however,in common ventilation group,there were 30 cases who had improved after 24 hours and 50 cases had improved after 72 hours,x2 =15.372 and 7.584,P 〈 0.01,there was statistical difference for two groups.However,there were not different in cerebral injury/healing damage and retinopathy of prematurity （ROP） for two groups.Conclusions High frequency oscillation is an effective way to treat RDS of premature.