不同机械通气方式联合肺表面活性剂对新生儿急性呼吸窘迫综合征呼吸力学的影响

Effections of different ways of mechanical ventilation with pulmonary surfactant on respiratory mechanics of patients with neonatal acute respiratory distress syndrome

目的:研究高频振荡通气+肺表面活性剂(HFOV+PS)、常频机械通气+肺表面活性剂(CMV+PS)、常频机械通气(CMV)治疗方式对新生儿急性呼吸窘迫综合征(ARDS)呼吸力学及疗效的影响。方法:纳入符合ARDS诊断标准的新生儿75例,HFOV+PS组25例,CMV+PS组30例,CMV组20例,前两组应用PS 70 mg/kg一次,分别检测机械通气0、12、24、48、72 h的PaO_2、PaCO_2、PaO_2/FiO_2、氧合指数(OI)、呼吸指数(RI)。结果:HFOV+PS组在机械通气12、24、48 h比较PaO_2均高于CMV+PS、CMV组,PaCO_2均低于CMV+PS、CMV组(P<0.05);在机械通气12、24、48、72 h比较PaO_2/FiO_2均高于CMV+PS、CMV组,OI、RI均低于CMV+PS、CMV组(P<0.05);机械通气时间、用氧时间比较均低于CMV+PS、CMV组(P<0.05);3组气漏、颅内出血发生率及治愈率比较差异无统计学意义(P>0.05)。结论:应用HFOV联合PS治疗新生儿ARDS可及时改善氧合功能,缩短机械通气及用氧时间,不增加并发症发生。

Objective To investigate the respiratory mechanics and treatment outcomes of different types of mechanical ventilation for patients with neonatal acute respiratory distress syndrome （ARDS） ： the high frequency oscillation ventilation ＋ pulmonary surfactant （HFOV ＋ PS） , conventional mechanical ventilation ＋ puhnonary surfactant （CMV＋ PS） , conventional mechanical ventilation （CMV）. Methods Seventy-five cases with neonatal ARDS, 25 cases in the HFOV ＋ PS group, 30 cases in the CMV ＋ PS group, 20 cases in the CMV group. Patients in the former two groups received 70 mg/kg PS at a time. PaO2, PaCO2, PaO2/FiO2, oxygenation index （O1） and respiratory index （RI） were detected at 0 h, 12 h, 24 h, 48 h, 72 h post-mechanical ventilation. Results At 12, 24, and 48 hours post-mechanical ventilation, patients in the HFOV＋PS group had a significantly higher level of PaO2 and a significantly lower level of PaCO2 than those of patients in the CMV＋PS group and the CMV group （P 〈 0.05）. At 12, 24, 48, and 72 hours post-mechanical ventilation, patients in the HFOV ＋PS group had a significantly higher level of PaO2/FiO2 and significantly lower level of OI and RI than those of patients in the CMV＋ PS group and the CMV group （P 〈 0.05, respectively）. Patients in the HFOV＋PS group also had significantly shorter durations of mechanical ventilation and oxygen usage than those of patients in the CMV＋PS group and the CMV group （P 〈 0.05）. No significant differences were observed in Gas leak, the incidence of intracerebral haemorrhage and cure rate among the three groups. Conclusions Application of HFOV with PS therapy for patients with neonatal ARDS can timely improve the oxygenation, shorten the time of mechanical ventilation and the usage of oxygen, without increasing complications.