高频振荡通气联合一氧化氮吸入治疗新生儿低氧性呼吸衰竭疗效观察

Efficacy of High Frequency Oscillatory Ventilation Combined with Inhaled Nitric Oxide For treating Neonatal Hypoxic Respiratory Failure

目的探讨高频振荡通气联合一氧化氮吸入治疗新生儿难治性低氧性呼吸衰竭的临床效果。方法 2012年1月至2019年12月在我院新生儿科住院的足月新生儿重症肺炎并发难治性低氧性呼吸衰竭的患儿25例,经高频振荡通气和/或肺泡表面活性物质治疗2小时后仍存在低氧性呼吸衰竭,即高频振荡通气中吸入FiO2>60%,PaO2仍<50mmHg,SpO2<80%,在原治疗基础上加用一氧化氮吸入治疗,回顾性分析治疗前和治疗后1小时、12小时、24小时的血气分析、PaO2/FiO2、机械通气参数。结果所有病例血气分析结果、PaO2/FiO2、机械通气参数在治疗1小时、12小时、24小时均较治疗前改善(P均<0.05)。患儿各项生命指征平稳,没有发生高铁血红蛋白血症及出血情况。结论高频振荡通气联合一氧化氮吸入治疗新生儿难治性低氧性呼吸衰竭是安全有效的。

Objective To investigate the clinical effect of high frequency oscillatory ventilation combined with ni⁃tric oxide inhalation in the treatment of refractory hypoxic respiratory failure in neonates.Methods From Janu⁃ary 2012 to December 2019,25 full-term infants with severe neonatal pneumonia complicated with refractory hypoxic respiratory failure admitted to the neonatal department of our hospital were treated with high-frequency oscillatory ventilation and/or alveolar surfactant for 2 hours and still suffered from hypoxic respiratory failure,i.e.inhalation FiO2>60%,PaO2<50mmHg,SpO2<80%.In addition to the original treatment,nitric oxide inhala⁃tion therapy was applied,and blood gas analysis,PaO2/FiO2 and mechanical ventilation parameters before and 1,12,24 hours after treatment were retrospectively analyzed.Results Blood gas analysis,PaO2/FiO2 and mechani⁃cal ventilation parameters in all cases were improved after treatment I,12 and 24 hours(P<0.05).All vital signs of the child were stable and no methemoglobinemia or hemorrhage occurred.Conclusion High frequency oscilla⁃tory ventilation combined with nitric oxide inhalation is safe and effective in the treatment of neonatal refractory hypoxic respiratory failure.