高频振荡通气联合容量保证通气在超早产儿呼吸窘迫综合征的应用价值

The Value of High Frequency Oscillatory Ventilation Combined with Volume Guarantee in Extremely Preterm Infants with Respiratory Distress Syndrome

背景超早产儿早期低碳酸血症与脑室内出血(IVH)和支气管肺发育不良(BPD)有关。国外研究结果显示高频振荡通气联合容量保证通气(HFOV+VG)可以减少早产儿的低碳酸血症,但胎龄<28周出生的超早产儿使用HFOV+VG的研究甚少。目的探讨HFOV+VG治疗超早产儿呼吸窘迫综合征的临床疗效。方法选择2020年3月—2023年3月新乡市中心医院(新乡医学院第四临床学院)NICU收治的胎龄<28周且出生体质量<1000 g,需要有创机械通气的呼吸窘迫综合征超早产儿作为研究对象,根据随机数字表法分为HFOV+VG组和同步间歇指令通气(SIMV)组。试验开始后48 h检查动脉血气分析,观察2组的有创通气时间、总呼吸支持时间、病死率以及低碳酸血症、脑室周围白质软化(PVL)、早产儿视网膜病变(ROP)、晚发型败血症(LOS)、气胸、呼吸机相关性肺炎(VAP)、BPD、新生儿坏死性小肠结肠炎(NEC)及3~4级脑室周围-脑室内出血(IVH)发生率。结果HFOV+VG组有创通气时间、总呼吸支持时间较SIMV组短,低碳酸血症、PVL的发生率均低于SIMV组(P<0.05);两组ROP、LOS、气胸、VAP、BPD、NEC及3~4级IVH发生率比较,差异均无统计学意义(P>0.05)。结论与SIMV通气相比,HFOV+VG通气应用于胎龄<28周的超早产儿RDS临床效果更好,且不增加不良反应。

Background Early hypocapnia in extremely preterm infants is associated with intraventricular hemorrhage(IVH)and bronchopulmonary dysplasia(BPD).The results of foreign studies show that high frequency oscillatory ventilation combined with volume guarantee ventilation(HFOV+VG)has been confirmed to reduce hypocapnia in preterm infants,but less is known of using HFOV+VG in extremely preterm infants born at<28 weeks gestational age.Objective To investigate the clinical efficacy of HFOV+VG in the treatment of respiratory distress syndrome with extremely premature infants.Methods Extremely preterm infants with respiratory distress syndrome admitted to the NICU of Xinxiang Central Hospital(the Fourth Clinical College of Xinxiang Medical College)at a gestational age of<28 weeks and a birth weight of<1000 g,who required invasive mechanical ventilation,were prospectively selected as the study subjects and were divided into the HFOV+VG group and the synchronized intermittent mandatory ventilation(SIMV)group according to the randomized numeric table method.Arterial blood gas analysis was performed 48h after trial initiation for invasive ventilation duration,total respiratory support duration,case fatality,and incidence of hypocapnia,periventricular leukomalacia(PVL),retinopathy of prematurity(ROP),late onset sepsis(LOS),pneumothorax,ventilator-associated pneumonia(VAP),bronchopulmonary dysplasia(BPD),neonatal necrotizing enterocolitis(NEC),and grade 3-4 periventricular-intraventricular hemorrhage(IVH).Results In HFOV+VG group,the duration of invasive ventilation and total respiratory support time were shorter than SIMV group,and the incidence of hypocapnia and PVL were lower than SIMV group,and there were all significant statistical differences the two groups(P<0.05),while the incidence of ROP,LOS,pneumothorax,VAP,BPD,NECand grade 3-4 IVH were not significant(P>0.05).Conclusion Compared with SIMV ventilation,HFOV+VG ventilation in extremely preterm infants born at<28 weeks gestational age has better clinical results and does not increase adverse effects,which deserves clinical promotion.