不同参数调节下nHFOV治疗新生儿呼吸窘迫综合征的疗效研究

Effect of non-invasive high-frequency oscillatory ventilation under different parameters adjustment in treating neonatal respiratory distress syndrome

目的探讨不同参数调节下无创高频振荡通气(nHFOV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法将2019年10月至2021年6月该院新生儿病区收治的57例出生后确诊为NRDS的患儿随机分为A组[平均气道压(MAP)6~8 cm H_(2)O、振幅10~<12级,13例]、B组(MAP 6~8 cm H_(2)O、振幅12~15级,15例)、C组(MAP 4~<6 cm H_(2)O、振幅10~<12级,14例)和D组(MAP 4~<6 cm H_(2)O、振幅12~15级,15例)。4组患儿呼吸机参数:频率均为6~8 Hz,吸入氧浓度(FiO_(2))均为20%~40%,吸气与呼气比(I∶E)均为1∶1。比较4组患儿呼吸机治疗前、治疗后12、36、72 h动脉血气变化[包括动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、氧合指数(OI)等],以及肺泡表面活性物质使用率、气管插管率、机械通气时间、住院时间、不良事件发生率等。结果4组患儿治疗前PaO_(2)、PaCO_(2)、OI比较,差异均无统计学意义(P>0.05);4组患儿治疗12、36、72 h后PaO_(2)、PaCO_(2)、OI均优于治疗前,且A组患儿治疗12、36、72 h后PaO_(2)、PaCO_(2)均优于B组、C组和D组,差异均有统计学意义(P<0.05);A组患儿机械通气时间、住院时间均短于D组,差异均有统计学意义(P<0.05);4组患儿PS使用率、气管插管率、不良事件发生率比较,差异均无统计学意义(P>0.05)。结论呼吸机参数调节为MAP 6~8 cm H_(2)O、振幅10~12级、频率6~8 Hz、FiO_(2)20%~40%能达到肺的最佳开放压,有效降低NRDS患儿PaCO_(2),并能提高其PaO_(2),缩短机械通气时间及住院时间,且不会增加不良事件发生,是一种安全、有效的呼吸机参数调节模式。

Objective To investigate the clinical effect of non-invasive high-frequency oscillatory ventilation under different parameters in the treatment of neonatal respiratory distress syndrome(NRDS).Methods Fifty-seven neonatal patients with NRDS diagnosed after birth in the neonates department of this hospital from October 2019 to June 2021 were randomly divided into the group A[mean airway pressure(MAP)6-8 cm H_(2)O,amplitude 10-<12 grade,14 cases]group B(MAP 6-8 cm H_(2)O,amplitude 12-15 grade,15 cases),group C(MAP 4-<6 cm H_(2)O,amplitude 10-<12 grade,14 cases)and group D(MAP 4-<6 cm H_(2)O,amplitude 12-15 grade,15 cases).The ventilator parameters in the four groups were the frequency(f)6-8 Hz,the inhaled oxygen concentration(FiO_(2))20%-40%and I∶E 1∶1.The changes of arterial blood gas before treatment and at 12,36,72 h after receiving breathing machine(including PaO_(2),PaCO_(2),OI,etc.),use rate of polmonary surfactant(PS),rate of endotracheal intubation,time of mechanical ventilation,length of hospital stay and incidence rate of adverse events were compared among 4 groups.Results There was no statistically significant difference in PaO_(2),PaCO_(2) and OI before treatment among the four groups(P>0.05);PaO_(2),PaCO_(2) and OI after 12,36 and 72 h treatment in the four groups were better than those before treatment,moreover,PaO_(2) and PaCO_(2) after 12,36 and 72 h treatment in the group A were significantly better than those in the group B,C and D,and the differences were statistically significant(P<0.05).The time of mechanical ventilation and hospital stay in the group A were significantly less than those in the group D,and the differences were statistically significant(P<0.05);there was no statistically significant difference in the PS use rate,endotracheal intubation rate and incidence rate of adverse events among the four groups(P>0.05).Conclusion Adjusting the ventilator parameters as MAP 6-8 cm H_(2)O,amplitude 10-12 grade,frequency 6-8 Hz,FiO_(2)20%-40%could achieve the best open pressure of the lung,effectively reduce PaCO_(2) in the patients with NRDS,increase PaO_(2),shorten the mechanical ventilation time and hospitalization time,morever does not increase the incidence rate of adverse events,which is a safe,effective ventilator parameter adjustment mode.