一氧化氮吸入联合高频震荡通气治疗新生儿严重呼吸衰竭的疗效分析

Efficacy of combination therapy with inhaled nitric oxide and high-frequency oscillation ventilation in the treatment of neonatal hypoxemic respiratory failure

目的探讨一氧化氮吸入(iNO)联合高频震荡通气(HFOV)治疗新生儿严重呼吸衰竭疗效。方法选取2013年3月至2016年3月60例HFOV中高参数设置下氧合差的患儿[吸入氧浓度(FIO_2)>60%,经皮血氧饱和度(TcSO_2)<80%],采用随机数字表法分为观察组及对照组,观察组予iNO联合HFOV治疗,对照组予单纯HFOV治疗,治疗中监测血气分析、血氧饱和度、血压、心率,监测血常规、出凝血时间、高铁血红蛋白等指标。比较两组的机械通气时间、救治成功率以及并发症发生率。结果 iNO联合HFOV,能显著改善患儿氧合指数,使呼吸机参数逐渐下调至安全范围,且合理调整参数后患儿无明显不适,缩短患儿机械通气时间,提高呼吸衰竭患儿的抢救成功率。机械通气时间对照组为(107.00±39.60)h,观察组为(89.34±22.75)h,两组比较,差异有统计学意义(P<0.05);死亡率对照组32.14%,观察组9.37%,两组比较,差异有统计学意义(P<0.05)。观察组在未用iNO之前PH值、氧分压(PaO_2)、二氧化碳分压(PaCO_2)、动脉氧分压与吸入氧浓度比(PaO_2/FiO_2)、氧合指数(OI)值均差异无统计学意义(P>0.05)。iNO后2 h、24 h比较差异有统计学意义(P<0.05)。结论 iNO联合HFOV可以显著改善肺血管性痉挛导致的新生儿严重呼吸衰竭患儿的氧合,有效且相对安全,提高患儿的存活率。

Objective The objective of this essay is to study the efficacy of treating neonatal severe respiratory failure by combining inhaled nitric oxide(iNO)with high-frequency oscillation ventilation(HFOV).Methods We selected 60 children patients who have the problem of inadequate oxygenation(FIO 2>60%,TcSO 2<80%)with a high parameter set in HFOV from 2013-2016.We treat the experimental arm by INO combined with HFOV,and the control arm by HFOV only.During the treatment,blood-gas analysis,oxygen saturation,blood pressure,heart rate,blood routine,coagulating time and methemoglobin were taken.Based on randomized control principle,the mechanical ventilation time,survival rate and incidence of complications were compared.Results The conjoint therapy can significantly improve the patients′oxygenation index and without much discomfort when the ventilator is adjusted to a safe setting range.The therapy reduces the ventilation time but increases the survival rate of the patients with respiratory failure.The mechanical ventilation time(H),of the control group and the experimental group were(107±39.60)and(89.34±22.75),respectively(P<0.05).The mortality rate of the control group and the experimental group were 32.14%and 9.37%(P<0.05).pHvalues,PaO 2,PaCO 2,PaO 2/FiO 2 and OI values did not differ significantly between the two group(P>0.05).There was significant difference between 2 hours and 24 hours after iNO(P<0.05).Conclusions The conjoint therapy can effectively improve the severerespiratory failure patients′oxygenation caused by pulmonary vasospasm in a relatively safe way,thus promote the survival rate of the patients.