无创高频通气治疗新生儿呼吸窘迫综合征临床疗效分析

Clinical analysis of noninvasive high frequency ventilation in the treatment of neonatal respiratory distress syndrome

目的:探讨使用无创高频振荡通气和CPAP通气模式治疗新生儿呼吸窘迫综合征,比较二者治疗效果及并发症发生率,是否可减少上机时间及住院天数等。方法:选择河南省周口市中心医院新生儿重症监护病房(NICU)2016-03—2018-03期间收治的RDS患儿74例,分为无创高频组(NHFV组)36例及无创正压通气组(NCPAP组)38例,比较两组上机前和上机后12、24、48、72h动脉血气变化、并发症发生情况、上机时间等。结果:NHFV组PO_2、a/APO_2、SaO_2在给予呼吸支持后12、24、48、72h均高于NCPAP组,差异均有统计学意义(均P<0.05);NHFV组PaCO_2在给予呼吸支持后12、24、48、72h均低于NCPAP组,差异具有统计学意义(均P<0.05);两组患儿均痊愈出院,在气漏、持续肺动脉高压、支气管肺发育不良、视网膜病、肺出血、颅内出血等并发症发生率方面,其差异无统计学意义(P>0.05);NHFV组在气管插管、上机时间及住院天数均少于NCPAP组,差异具有统计学意义(P<0.05)。结论:无创高频通气治疗RDS疗效确切,且与CPAP通气模式相比,可减少RDS患儿CO_2潴留,增加氧合指数,减少上机时间及住院天数,值得临床推广应用。

Objective:To investigate the treatment of neonatal respiratory distress syndrome by use of noninvasive high-frequency oscillatory ventilation and CPAP ventilation mode,compare the treatment effect and the incidence of complications,whether can reduce ventilator time and hospitalization days,etc.Method:Seventy-four cases of RDS,who were hospitalized in neonatal intensive care unit(NICU)of Zhoukou central hospital,Henan province in March 2016 to March 2018,were divided into two groups(36 cases in NHFV group and 38 cases in NCPAP group).Arterial blood gas changes,complications were compared before and on 12 h,24 h,48 h,72 hafter,ventilation treatment.Result:PO2,a/APO2 and SaO2 in NHFV group were all higher than those in NCPAP group at 12 h,24 h,48 h and 72 hafter respiratory support(all P<0.05).PaCO2 in NHFV group was lower than that in NCPAP group(all P<0.05)at 12 h,24 h,48 hand 72 hafter respiratory support,and the difference was statistically significant.Two groups of patients were cured and discharged.There was no significant difference statistically significant in the gas leakage,continuous pulmonary hypertension,bronchial pulmonary dysplasia,retinal disease,pulmonary hemorrhage and intracranial bleeding complications between two groups(P>0.05).NHFV group had less tracheal intubation,ventilator time,hospitalization days than NCPAP group,and the difference was statistically significant(P<0.05).Conclusion:Compared with CPAP ventilation mode,the efficacy of in the treatment of RDS is more accurate,and noninvasive high frequency ventilation can reduce CO2 retention,increase oxygenation index,reduce ventilator time and hospitalization days.It is worthy of clinical popularization and application.