两种机械通气模式治疗新生儿肺炎合并气胸的疗效比较

Therapeutic evaluation of two mechanical ventilation models in treatment of neonatal pneumonia complicating pneumothorax

目的评估同步间歇指令通气(SIMV)及高频振荡通气(HFOV)两种通气模式治疗新生儿肺炎合并气胸的疗效及安全性。方法回顾性分析东南大学医学院附属江阴医院2012年9月至2016年4月接受SIMV(11例)及HFOV通气(13例)共24例新生儿肺炎合并气胸患儿的临床资料,比较两组患儿治疗前及治疗后2、12、24及48小时的氧分压(Pa O2)、二氧化碳分压(Pa CO2)、氧合指数(OI),以及两组患儿肺泡复张、拔除胸腔闭式引流管、机械通气及住院时间,两组患儿颅内出血及脑室周围白质软化等表现。结果 24例患儿均治愈。毎组患儿Pa O2、Pa CO2、OI均较治疗前改善,差异有统计学意义。治疗后2小时,HFOV组Pa O2、Pa CO2及OI改善较SIMV组显著(P<0.05),治疗后12及24小时,HFOV组Pa O2及OI亦较SIMV组改善显著(P<0.05)。两组患儿肺泡复张及拔除胸腔闭式引流管的时间比较,差异无统计学意义(P>0.05)。机械通气的时间及住院时间比较,SIMV组均显著长于HFOV组(P<0.05)。两组患儿头颅MRI检查均未见颅内出血、脑室周围白质软化等表现。结论 SIMV及HFOV两种通气方式在气胸治疗中均安全、有效。HFOV能显著改善肺炎合并气胸患儿的氧合功能,缩短上机时间及住院时间。

Objective To evaluate the efficacy and safety of SIMV and HFOV in the treatment of neonatal pneumonia complicating pneumothorax. Methods A retrospectively analysis was done in the clinical data of 24 cases of neonatal pneumonia complicating pneumothorax who accepted mechanical ventilation from Sept 1, 2012 to April 30, 2016, and among them 11 received SIMV and 13 undertook HFO. Data of PaO2, PaCO2 and OI before and 2 hours, 12 hours, 24 hours and 48 hours after mechanical ventilation in two groups were analyzed, so were the time of alveolar recruitment, removal of chest drainage tube, mechanical ventilation and hospitalization. Also, the incidence of intracranial hemorrhage and periventricular leukomalacia was assessed. Results All of the 24 patients were cured. Data of PaO2, PaCO2 and OI after mechanical ventilation were significantly different from those before mechanical ventilation, suggesting the efficacy of the treatment. PaO2, PaCO2 and OI after 2 hours＇ treatment in HFO group was significantly improved compared with those in SIMV group, so were PaO2 and OI after 12 and 24 hours＇ treatment. There was no significant difference in alveolar recruitment and thoracic drainage tube removal time between the two groups. Time of mechanical ventilation and hospitalization of SIMV group was longer than that of HFOV group. Cranial MRI examination showed no intracranial hemorrhage, periventricular leukomalacia and other symptoms in both groups. Conclusion Both SIMV and HFOV are effective and safe in the treatment of pneumothorax. HFOV can significantly improve the oxygenation of pneumonia pneumothorax and shorten time of mechanical ventilation and hospitalization as well.