两种通气在新生儿呼吸衰竭中的应用效果分析

The effect of normal frequency mechanical ventilation vs.nasal continuous positive airway pressure ventilation in the treatment of neonatal respiratory failure

目的对比常频机械通气和鼻塞式持续气道正压通气在治疗新生儿呼吸衰竭的临床应用效果。方法选取2013年1月至2014年10月该院新生儿重症监护室收治的诊断为新生儿呼吸衰竭的患儿60例,分为观察组31例和对照组29例。观察组予鼻塞式持续气道正压通气,对照组给予常频机械通气治疗。观察两组治疗前及治疗后2d内的X线胸片并评分,记录两组患儿3d存活率、血气分析指标、呼吸机相关肺炎、上机时间、肺出血的情况。结果治疗后24h,观察组较对照组下降明显(P<0.05),与治疗前比较差异均有统计学意义(P<0.05)。3d存活率观察组93.50%明显高于对照组82.76%,差异有统计学意义(P<0.05)。治疗后,两组pH、PO_2比较差异有统计学意义(P<0.05),PCO_2差异无统计学意义(P>0.05)。观察组上机时间,肺出血、呼吸机相关性肺炎发生率均小于对照组,但差异无统计学意义(P>0.05)。结论临床上给予患儿鼻塞式持续气道正压与常频机械通气均可有效防治新生儿的呼吸衰竭,短期疗效鼻塞式持续气道正压通气要优于常频机械通气,可有效减少呼吸道出现相关肺炎的发生率。

Objective To contrast clinical effect of normal frequency mechanical ventilation vs .nasal continuous positive air‐way pressure ventilation in the treatment of neonatal respiratory failure .Methods Sixty children diagnosed as neonatal respiratory failure were enrolled in our hospital from January 2013 to October 2014 ,and the children were randomly divided into observation group （n=31） and control group （n=29） .Observation group were given nasal continuous positive airway pressure ,children with the control group received normal frequency mechanical ventilation .The X‐ray of the two groups before treatment and 2 d after treatment were observed and scored ,the 3 d survival rate ,blood gas analysis index ,ventilator associated pneumonia ,time of opera‐tion ,and incidence of pulmonary hemorrhage were observed in the two groups .Results The X‐ray results showed that ：after treat‐ment ,the two groups of children with X‐ray film scores were gradually decreased ,compared with before treatment ,the difference was statistically significant （P〈0 .05）;the observation group decreased significantly after treatment 24 h compared with the control group ,the difference was statistically significant （P〈0 .05）;the survival rate of 3 d in the observation group（93 .50% ） was signifi‐cantly higher than that in the control group（82 .76% ） ,the difference was statistically significant （P〈0 .05） .The pH in observation group was less than the control group ,PO2 was greater than the control group ,the difference was statistically significant （P〈0 . 05） ,the PCO2 in observation group was less than the control group ,but the difference was not statistically significant （P〉0 .05） . Time ,incidence of pulmonary hemorrhage and incidence of ventilator associated pneumonia in observation group were less than those in control group ,the difference was not statistically significant （P〉0 .05） .Conclusion The normal frequency of mechanical ventilation and nasal continuous positive airway pressure can be effective reducing the relevance of respiratory pneumonia in the treatment of neonatal respiratory failure ,short‐term effect of nasal continuous positive airway pressure is slightly better than normal frequency mechanical ventilation .