高频振荡通气联合吸入一氧化氮治疗新生儿低氧性呼吸衰竭疗效分析

Analysis of curative effect of high frequent oscillation ventilation combined with inhaled nitric oxide for neonatal hypoxic respiratory failure

目的 比较高频振荡通气（HFOV）与HFOV联合吸入一氧化氮（iNO）（HFOV＋iNO）治疗新生儿低氧性呼吸衰竭（NHRF）的疗效。方法 回顾性分析德宏州人民医院新生儿科2015年1月至2016年12月诊治的NHRF患儿共60例，按治疗方式不同分为2组：HFOV组32例，HFOV＋iNO组28例。比较2组患儿氧合指数（OI）、动脉血二氧化碳分压[pa（CO2）]及并发症的差异。结果 2组患儿出生时间、胎龄、出生体质量、性别比例、基础疾病比较差异均无统计学意义（均P〉0.05），组间具有可比性；OI在2组患儿呼吸机治疗第0小时（27.8±3.5比27.6±3.7）差异无统计学意义（t＝0.04，P〉0.05）；治疗8 h、16 h、24 h HFOV＋iNO组OI（分别为11.2±3.4、7.3±3.0、7.0±2.6）较HFOV组（分别为14.5±3.3、9.6±3.0、8.5±2.8）明显下降，差异均有统计学意义（t＝3.81、5.16、2.14，均P〈0.05）；pa（CO2）在2组患儿呼吸机治疗第0小时[（65.14±14.97） mmHg（1 mmHg＝0.133 kPa）比（64.79±13.40） mmHg]差异无统计学意义（t＝0.095，P〉0.05）；治疗8 h、16 h、24 h 2组比较，差异均无统计学意义[8 h：（50.71±10.49） mmHg比（49.02±11.74） mmHg，16 h：（40.99±12.38） mmHg比（40.02±12.04） mmHg，24 h：（39.01±9.80） mmHg比（38.00±7.85） mmHg，均P〉0.05]；2组患儿在肺气漏、肺出血、颅内出血、血小板〈100×109/L、高铁血红蛋白水平〉3%、凝血功能异常发生率间的差异均无统计学意义（均P〉0.05）。结论 HFOV及HFOV＋iNO治疗NHRF均有效，HFOV＋iNO较HFOV疗效显著。HFOV＋iNO治疗NHRF安全、有效，与HFOV治疗比较短期内并发症无增加。

Objective To compare the curative effect with high frequent oscillation ventilation （HFOV） and with HFOV＋ inhaled nitric oxide（iNO） in the treatment of neonatal hypoxic respiratory failure（NRHF）.Methods Data of 60 NHRF patients in the People′s Hospital of Dehong Prefecture from January 2015 to December 2016 were retrospectively analyzed.The patients were divided into HFOV group （32 cases） and HFOV＋ iNO group （28 cases） according to the treatment methods.The comparison between the 2 groups was established as following： oxygenation index（OI）, arterial partial pressure of carbon dioxide[pa（CO2）] and complications.Results There was no significant difference between the 2 groups in time of birth, gestational age, birth weight, gender ratio and original diseases（all P〉0.05）. As for OI there was no significant difference at 0 h between the 2 groups（27.8±3.5 vs. 27.6±3.7）（t=0.04, P〉0.05）; OI of HFOV＋ iNO group （11.2±3.4, 7.3±3.0, 7.0±2.6, respectively） was more significantly decreased than that in the HFOV group （14.5±3.3, 9.6±3.0, 8.5±2.8, respectively） at 8 h, 16 h, 24 h, and there were significant differences between the 2 groups（t=3.81, 5.16, 2.14, all P〈0.05）. As for pa（CO2） there was no significant difference at 0 h [（65.14±14.97） mmHg vs.（64.79±13.40） mmHg]（t=0.095, P〉0.05）; the changes in pa（CO2） had no statistically significance difference between HFOV＋ iNO group and HFOV group at 8 h, 16 h, 24 h[8 h： （50.71±10.49） mmHg vs.（49.02±11.74） mmHg, 16 h： （40.99±12.38） mmHg vs.（40.02±12.04） mmHg, and 24 h： （39.01±9.80） mmHg vs.（38.00±7.85） mmHg, all P〉0.05]. As for the complications, there was no difference between the 2 groups in pulmonary air leak, pneumorrhagia, intracranial hemorrhage, blood platelet〈100×109/L, methemoglobin concentration〉3%, or dysfunction of blood coagulation （all P〉0.05）.Conclusion Both HFOV and HFOV＋ iNO methods are effective for NRHF.Treatment with HFOV＋ iNO method is more effective.Treatment for NHRF with HFOV＋ iNO is safe, effective, without complication increase in a short term.