鼻塞式高频振荡通气治疗早产儿呼吸窘迫综合征疗效观察

Effect of nasal high frequency oscillatory ventilation in the treatment of premature infants with respiratory distress syndrome

目的探讨鼻塞式高频振荡通气(NHFOV)治疗极低出生体质量早产儿呼吸窘迫综合征(RDS)的临床效果。方法选取2015年1月至2016年5月新乡市中心医院收治的75例极低出生体质量RDS早产儿,分为NHFOV组40例,鼻塞式持续气道正压通气(NCPAP)组35例。患儿入院后立即开始无创呼吸支持,比较2组患儿入院后0、1、12、24 h动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)及氧合指数(OI),以及无创通气时间、治疗失败后机械通气率及支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、脑室内出血(IVH)、脑室周围白质软化(PVL)等并发症发生情况。结果 2组患儿入院后0 h PaCO_2、PaO_2和OI比较差异均无统计学意义(P>0.05)。NHFOV组患儿入院后1、12、24 h的PaCO_2与NCPAP组比较均显著降低(P<0.05),PaO_2、OI与NCPAP组比较均显著升高(P<0.05)。与入院后0 h时比较,2组患儿入院后1、12、24 h的PaCO_2均显著降低(P<0.05),PaO_2和OI均显著升高(P<0.05);与入院后1 h时比较,2组患儿入院后12、24 h的PaCO_2均显著降低(P<0.05),PaO_2和OI均显著升高(P<0.05);与入院后12 h时比较,2组患儿入院后24 h的PaCO_2均显著降低(P<0.05),PaO_2和OI均显著升高(P<0.05)。NHFOV组患儿无创呼吸支持时间显著短于NCPAP组(P<0.05)。NHFOV组患儿无创呼吸支持失败后需机械通气比例显著低于NCPAP组(P<0.05)。2组患儿BPD、ROP、IVH及PVL发生率比较差异均无统计学意义(P>0.05)。结论 NHFOV治疗极低出生体质量早产儿RDS能有效改善氧合,减少CO_2潴留、机械通气率及无创通气时间。

Objective To investigate the clinical effect of nasal high frequency oscillatory ventilation（NHFOV） in the treatment of very low birth weight preterm infants with respiratory distress syndrome （RDS）.Methods Seventy-five very low birth weight preterm infants with RDS were selected from January 2015 to May 2016 in the Central Hospital of Xinxiang City.The patients were divided into NHFOV group （NHFOV） and nasal continuous positive airway pressure （NCPAP） group（n =35）.The patients were immediately treated with noninvasive respiratory support after hospitalization.The arterial partial pressure of carbon dioxide （PaCO2）,arterial partial pressure of oxygen （PaO2） and oxygenation index （OI） at the time points of 0,1,12,24 h after hospitalization were compared between the two groups.The noninvasive ventilation time and mechanical ventilation rate after treatment failure were compared between the two groups;and the incidences of bronchopulmonary dysplasia （BPD）,retinopathy of prematurity （ROP）,intraventricular hemorrhage （IVH） and periventricular leukomalacia （PVL） were compared between the two groups.Results There was no significant difference in PaCO2,PaO2 and OI between the two groups at the 0 h after admission （P 〉0.05）.The PaCO2 in NHFOV group was significantly lower than that in NCPAP group （P 〈 0.05）,and the PaO2 and OI in NHFOV group were significantly higher than those in NCPAP group at the time points of 1,12,24 h after admission （P 〈 0.05）.Compared with 0 h after admission,the PaCO2 was significantly decreased （P 〈 0.05）,and the PaO2 and OI were significantly higher （P 〈 0.05） at the time points of 1,12,24 h after admission in the two groups （P 〈 0.05）.Compared with 1 h after admission,the PaCO2 was significantly decreased （P 〈 0.05）,and the PaO2 and OI were significantly higher （P 〈0.05） at the time points of 12,24 h after admission in the two groups （P 〈0.05）.Compared with 12 h after admission,the PaCO2 was significantly decreased （P 〈 0.05）,and the PaO2 and OI were significantly higher （P 〈 0.05） at the time point of 24 h after admission in the two groups （P 〈 0.05）.The noninvasive respiratory support time in NHFOV group was significantly shorter than that in NCPAP group （P 〈 0.05）.The mechanical ventilation rate after treatment failure in NHFOV group was significantly lower than that in NCPAP group （P 〈 0.05）.There was no significant difference in the incidences of BPD,ROP,IVH and PVL between the two groups （P 〉 0.05）.Conclusion NHFOV can effectively improve oxygenation,decrease CO2 retention,mechanical ventilation rate and noninvasive ventilation time in very low birth weight preterm infants with RDS.