高频振荡通气治疗常频机械通气治疗失败后新生儿呼吸窘迫综合征的疗效及护理干预

Efficacy and nursing intervention of high-frequency oscillatory ventilation in the treatment of neonatal respiratory distress syndrome after failure of conventional mechanical ventilation

目的:研究常频机械通气(conventional mechanical ventilation,CMV)治疗失败后高频振荡通气(high-frequency oscillation ventilation,HFOV)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的疗效和护理干预。方法:于2017年8月至2019年1月在医院新生儿重症监护室(neonatal intensive care unit,NICU)进行随机、交叉、回溯性试验。根据治疗结果将患者分为存活组、体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗组和死亡组,统计患儿人口统计学资料,HFOV(0 h)前以及HFOV 1 h,6 h,24 h动脉血气指标如pH,PaO2,PaCO2,氧合指数(oxygenation index,OI)。结果:存活组患儿出生体重明显高于ECMO治疗组和死亡组,存活组FiO2明显低于ECMO治疗组和死亡组,存活组住院时间明显常于ECMO治疗组和死亡组。存活组患儿pH,PaCO2,PaO2,OI随治疗时间延长改善。结论:对于CMV治疗失败的NRDS患儿,HFOV可以提高患儿存活率,改善其预后,虽然设置合适的呼吸机参数可以进一步提高HFOV效果,但要进一步提高疗效,降低患儿病死率,仍需与ECMO结合。

Objective:To study the efficacy and nursing intervention of high frequency oscillatory ventilation(HFOV)in the treatment of neonatal respiratory distress syndrome(NRDS)after failure of Conventional mechanical ventilation(CMV).Methods:Randomized,crossover,retrospective trials were performed in the hospital neonatal intensive care unit(NICU)from August 2017 to January 2019.According to the treatment results,the patients were divided into the survival group,the ECMO treatment group,and the death group.The demographic data of the children,HFOV(0 h)and HFOV 1 h,6 h,24 h arterial blood gas indicators such as pH,PaO2,PaCO2,oxygenation index(OI).Results:The birth weight of the surviving group was significantly higher than that of the ECMO treatment group and the death group.The FiO2 in the survival group was significantly lower than that in the ECMO treatment group and the death group.The hospitalization time in the survival group was significantly higher than that in the ECMO treatment group and the death group.In the surviving group,the pH,PaCO2,PaO2,and OI improved with prolonged treatment time.Conclusion:HFOV can improve the survival rate and improve the prognosis of children with NRDS who have failed CMV treatment.Although setting the appropriate ventilator parameters can further improve the HFOV effect,it is necessary to further improve the efficacy and reduce the mortality of children.ECMO combination.