常频机械通气和高频振荡通气对低出生体质量儿呼吸窘迫综合征疗效及并发症的对比研究

Comparative Study of the Curative Effect and Complications of Conventional Mechanical Ventilation and High Frequency Oscillatory Ventilation on Low Weight Infants with Respiratory Distress Syndrome

目的比较常频机械通气(CMV)与高频振荡通气(HFOV)对低出生体质量儿呼吸窘迫综合征的疗效以及并发症的影响。方法选择2013年1月至2015年1月深圳市龙华新区人民医院收治的需行机械通气的低体质量儿呼吸窘迫综合征患儿103例,行常频机械通气49例为CMV组,行高频振荡通气54例为HFOV组,比较两组通气后3、12 h以及24 h的血气指标[动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、动脉血氧饱和度(SaO_2)、吸入氧浓度(FiO_2)、氧合指数(OI)]、24 h治疗有效率及1周内脑损伤及机械通气肺损伤的发生情况。结果机械通气24 h后CMV组治疗有效率与HFOV组比较差异无统计学意义(P>0.05)。两组PaCO_2、OI 在机械通气后3 h、12 h、24 h逐渐降低,两组PaCO_2、OI比较差异无统计学意义(P>0.05),时点间、组间·时点间比较差异有统计学意义(P<0.05)。两组FiO_2在机械通气后3 h、12 h、24 h逐渐降低,HFOV组下降速度更快,两组FiO_2在组间·时点间差异有统计学意义(P<0.05)。两组PaO_2在机械通气后3 h、12 h、24 h逐渐升高,两组在组间比较差异无统计学意义(P>0.05),在时点间、组间·时点间差异有统计学意义(P<0.05)。两组SaO_2在机械通气后3 h、12 h、24 h逐渐升高,两组在组间、组间·时点间比较差异无统计学意义(P>0.05),在时点间比较差异有统计学意义(P<0.05)。两组患儿1周内脑损伤及机械通气肺损伤发生率差异无统计学意义(P>0.05)。结论高频振荡通在短期内对低出生体质量儿呼吸窘迫综合征的肺通换气、氧合功能的改善效果更为显著。

Objective To compare the effects of constant frequency mechanical ventilation（CMV） and high frequency oscillatory ventilation（HFOV） on respiratory distress syndrome and brain damage in low weight infants with respiratory dis- tress syndrome. Methods A total of 103 cases low weight infants with respiratory distress syndrome needing mechanical ventilation in the People＇s Hospital of Longhua New District of Shenzhen City from Jan. 2013 to Jan. 2015 were included in the study：49 cases who received CMV as CMV group,and 54 cases who received HFOV as HFOV group, ,the blood gas indexes[partial pressure of carbon dioxide （PaCO~）,arterial blood oxygen Imrtial pressure（ Pa（~2 ）, bareerial lood oxygen saturation （ SaO2 ）, inhaled oxygen concentration（ FiO2 ） ,oxygen index （OI） ] after 3,12 h and 24 h of ventilation, the 24 h effective rate of the treatment and the incidence of brain injury and ventilator-induced lung injury within 1 week of the two groups were compared. Resultm The clinical effective rate of CMV group and HFOV group had no statistically significant difference（ P 〉 0. 05 ）after 24 hours of mechanical ventilation. The levels of PaC02 and OI of the two groups were reduced gradually after 3 h, 12 h, 24 h of mechanical ventilation. The differences of PaCO2 and 01 between the two groups had no statistical significance （P 〉 0.05 ）. The difference between the time pints and group time point had statistically signifi- cance （P 〈0. 05）, The levels of FiOz of the two groups were reduced gradually after 3 h,12 h,24 h of mechanical ventilation. HFOV group decreased faster. The difference between groups time point was statistically significant（ P 〈 0. 05 ）. The levels of PaO2 of the two groups were increased gradually after 3 h, 12 h, 24 h of mechanical ventilation. The difference between the two groups had no statistical significance （ P 〉 0. 05 ）. The differences between time points and groups time point were statistically significant（P 〈0, 05）. The levels of SaO2 of the two groups were increased gradually after 3 h, 12 h, 24 h ofmechanical ventilation. The differences between groups, group time point were no statistically significant （ P 〉 0. 05 ）, the difference between the time points was statistically significant（ P 〈 0. 05 ）. There was no significant difference in the incidence of brain injury and ventilator-induced lung injury between the two groups （ P 〉 0. 05 ）. Conclusion The effect of HFOV on pulmonary ventilation and oxygenation in low weight infants with respiratory distress syndrome is more signifi- cant in the short term.