高频振荡通气联合肺表面活性剂治疗新生儿急性呼吸窘迫综合征的效果及对氧合功能的影响

Effect of high-frequency oscillatory ventilation combined with pulmonary surfactant on neonatal acute respiratory distress syndrome and oxygenation function

目的比较高频振荡通气(high-frequency oscillatory ventilation,HFOV)联合肺表面活性剂(pulmonary surfactant,PS)、常频机械通气(conventional mechanical ventilation,CMV)联合PS治疗新生儿急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的疗效,及对氧合功能的影响。方法118例新生儿ARDS,56例行HFOV+PS治疗者为观察组,62例行CMV+PS治疗者为对照组。记录2组机械通气时间、撤机后用氧时间;分别于机械通气前(0h)及通气后12、24、48h监测患儿血酸碱度(pH)、pa(O2)、pa(CO2)、动脉血氧饱和度(arterial oxygen saturation,SaO2)、吸入氧浓度(fraction of inspired oxygen,FiO2),计算pa(O2)/FiO2、氧合指数(oxygenation index,OI)、呼吸指数(respiratory index,RI);治疗7d评价2组疗效,比较并发症发生率及病死率。结果观察组机械通气时间[(80.72±13.50)h]、撤机后用氧时间[(71.80±9.24)h]较对照组[(89.50±16.20)、(82.70±12.60)h]短(P<0.05);观察组机械通气后12、24、48hpH(7.38±0.68、7.43±0.75、7.46±0.73)、pa(O2)[(54.26±9.40)、(62.80±11.35)、(68.46±10.48)mm Hg]、SaO2[(94.63±1.84)%、(96.85±1.70)%、(98.60±1.83)%]及pa(O2)/FiO2[(240.80±38.50)、(270.40±41.20)、(293.50±43.60)mm Hg]较对照组[pH:7.30±0.74、7.36±0.72、7.40±0.65;pa(O2):(47.60±8.70)、(53.62±9.83)、(62.50±10.72)mm Hg;SaO2:(91.38±2.20)%、(94.10±1.65)%、(96.20±1.72)%;pa(O2)/FiO2:(208.30±36.70)、(236.50±37.30)、(261.70±42.20)mm Hg]高(P<0.05),pa(CO2)[(58.70±8.20)、(53.62±7.58)、(51.24±5.83)mm Hg]、OI(8.00±1.10、7.40±0.90、6.40±0.70)及RI(2.20±0.80、1.90±0.60、1.60±0.50)较对照组[pa(CO2):(64.25±8.73)、(60.18±7.40)、(56.37±6.82)mm Hg;OI:9.10±1.30、8.60±1.10、7.20±0.80;RI:3.10±1.10、2.70±0.90、2.30±0.70]低(P<0.05);2组机械通气后12、24、48hpH、pa(O2)、SaO2及pa(O2)/FiO2较0h升高,pa(CO2)、OI及RI均较0h降低(P<0.05);观察组治疗总有效率(94.6%)、并发症发生率(14.3%)及病死率(3.6%)与对照组(91.9%、21.0%、4.8%)比较差异无统计学意义(P>0.05)。结论HFOV联合PS、CMV联合PS治疗新生儿ARDS均可获得满意疗效,但应用HFOV联合PS可缩短机械通气及撤机后用氧时间,及时改善氧合功能,且不增加并发症发生率。

Objective To compare the effect of high-frequency oscillatory ventilation(HFOV)combined with pulmonary surfactant(PS)versus conventional mechanical ventilation(CMV)combined with PS on neonatal acute respiratory distress syndrome(ARDS)and its influence on oxygenation function.Methods In 118neonates with ARDS,56received HFOV+PS(observation group)and 62received CMV+PS(control group).The ventilation time and oxygen inhalation time after weaning were recorded.The pH value,pa(O2),pa(CO2),arterial oxygen saturation(SaO2)and fraction of inspired oxygen(FiO2)were monitored before ventilation,and 12,24 and 48 h after ventilation to calculate pa(O2)/FiO2,oxygenation index(OI)and respiratory index(RI).The effective rate,incidence of complications and fatality were compared between two groups after 7-day treatment.Results The total mechanical ventilation time and oxygen inhalation time after weaning were significantly shorter in observation group((80.72±13.50),(71.80±9.24)h)than those in control group((89.50±16.20),(82.70±12.60)h)(P<0.05).The levels of pH(7.38±0.68,7.43±0.75,7.46±0.73),pa(O2)((54.26±9.40),(62.80±11.35),(68.46±10.48)mm Hg),SaO2((94.63±1.84)%,(96.85±1.70)%,(98.60±1.83)%)and pa(O2)/FiO2((240.80±38.50),(270.40±41.20),(293.50±43.60)mm Hg)after ventilation for 12,24and 48hin observation group were significantly higher than those before ventilation in observation group and higher than those in control group(pH:7.30±0.74,7.36±0.72,7.40±0.65;pa(O2):(47.60±8.70),(53.62±9.83),(62.50±10.72)mm Hg;SaO2:(91.38±2.20)%,(94.10±1.65)%,(96.20±1.72)%;pa(O2)/FiO2:(208.30±36.70),(236.50±37.30),(261.70±42.20)mm Hg)(P<0.05),the levels of pa(CO2)((58.70±8.20),(53.62±7.58),(51.24±5.83)mm Hg),OI(8.00±1.10,7.40±0.90,6.40±0.70)and RI(2.20±0.80,1.90±0.60,1.60±0.50)were significantly lower than those before ventilation in observation group and lower than those in control group(pa(CO2):(64.25±8.73),(60.18±7.40),(56.37±6.82)mm Hg;OI:9.10±1.30,8.60±1.10,7.20±0.80;RI:3.10±1.10,2.70±0.90,2.30±0.70)(P<0.05),and the total effective rate,incidence of complications and fatality showed no significant differences between observation group(94.6%,14.3%,3.6%)and control group(91.9%,21.0%,4.8%)(P>0.05).Conclusion Both HFOV combined with PS and CMV combined with PS can achieve good results in the treatment of neonatal ARDS,but the former one could improve oxygenation function,shorten the time of mechanical ventilation and oxygen inhalation,and do not increase the incidence of complications.