无创高频振荡通气在胎粪吸入综合征并肺动脉高压机械通气撤机中的应用

Application of noninvasive high frequency oscillatory ventilation in neonates with meconium aspiration syndrome with pulmonary hypertension after extubation

目的比较经鼻无创高频振荡通气(NHFOV)和经鼻持续气道正压通气(NCPAP)在新生儿胎粪吸入综合征合并持续肺动脉高压机械通气撤机中的应用,以评鉴NHFOV的临床应用价值。方法选择入住本院新生儿科胎粪吸入综合征合并持续肺动脉高压患儿,撤机后随机分为NHFOV组和NCPAP组。观察无创呼吸支持后1、12、24 h血气氧分压(PaO_2)、二氧化碳分压(PaCO_2)、PaO_2/吸入氧浓度(fraction of inspired oxygen,FiO_2)。结果 NHFOV组无创呼吸支持后1、12、24 h PaCO_2与NCPAP组比较有明显降低[1 h:(41.1±7.2)mmHg vs.(45.4±6.7)mmHg,P=0.000;12 h:(38.9±3.1)mmHg vs.(44.6±5.2)mmHg,P=0.000;24 h:(35.1±8.2)mmHg vs.(43.2±7.1)mmHg,P=0.000],NHFOV组撤机失败率为11.43%,低于NCPAP组35.29%(P=0.021)。结论与NCPAP相比,撤机后使用NHFOV,可以更好减少二氧化碳潴留,降低撤机失败率。

Objective To investigate the clinical value of nasal noninvasive high frequency oscillatory ven- tilation （NHFOV） as a respiratory support after exhutation by comparing it with nasal continuous positive airway pressure （NCPAP） in neonates with meconium aspiration syndrome （MAS） and persistent pulmonary hypertension （PPHN）. Methods Sixty-nine infants of MAS with PPHN after exbutation from intensive care unit were randomly divided into NHFOV and NCPAP group. The value of blood oxygen pressure （PaO2）, carbon dioxide partial pres- sure （PaCO2） and PaO2/FiO2 at 1 h, 12 h, 24 h after extubation were monitored. And the rate of extubation fail- ure, total time on noninvasive ventilation, time to full feeds, pulmonary hemorrhage, intraventricular hemorrage （IVH） , nasal damage, abdominal distension, lung leakage were also monitored. Results The NHFOV group showed lower PaC02 than the NCPAP group at 1 h, 12 h and 24 h after noninvasive respiratory support [ 1 h： （41.1 ± 7.2）vs. （45.4± 6.7） ,P = 0.000; 12 h： （38.9±3.1）vs.（44.6 ± 5.2） ,P = 0.000;24 h： （35.1 ± 8.2）vs.（43.2 ± 7.1 ）, P = 0.0001. In this study, 11.43% infants were failed to be extubated in NHFOV group, hut 35.29% in NC- PAP group, and there was significant difference between the two groups （P = 0.021 ）. The NHFOV group had sig- nificantly lower incidence of nasal damage than the NCPAP group （5.71% vs. 32.35%; P = 0.002）. No significant differences were noted between the two groups in total time on noninvasive respiratory support, time to full feeds, pulmonary hemorrhage, IVH, nasal damage, abdominal distension and lung leakage （P 〉 0.05）. Conclusion Compared with NCPAP, NHFOV can better reduce carbon dioxide retention in the sequential therapy for neonates with MAS and PPHN after extubation. NHFOV can obviously decrease the rate of extubation failure, And it is a safe and effective ventilation mode.