高频振荡通气叠加常频通气治疗早产儿重症肺透明膜病的临床研究  

Effects of HFOV plus SIMV on premature newborns with hyaline membrane disease

作　　者：赵玉祥[1] 岳虹霓[1] 韩良荣[1] 刘石[1] 季东林[1] 陈莹[1] 

机构地区：[1]淮安市妇幼保健院新生儿科,江苏淮安223002

出　　处：《南京医科大学学报（自然科学版）》2010年第12期1745-1747,1763,共4页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:评价高频叠加常频通气模式治疗早产儿重症(Ⅲ～Ⅳ级)肺透明膜病(HMD)的临床疗效。方法:分析2005年1月～2010年1月在本院NICU住院治疗,且有完整资料的53例Ⅲ～Ⅳ级HMD早产儿的临床资料,按患儿开始上机时的首选通气模式分为研究组(高频振荡通气叠加常频SIMV模式)和对照组(常频通气模式),比较两组患儿上机后24 h胸片的改善、12 h和24 h血气变化、临床转归,以及气胸、颅内出血、支气管肺发育不良(BPD)等并发症的发生率。结果:研究组上机后24 h胸片的改善、12 h、24 h血氧分压变化、临床转归均优于对照组(P均<0.05);研究组气胸发生率低于对照组(P<0.05);在颅内出血与BPD的发生方面,两者无显著性差异(P均>0.05)。结论:高频叠加常频通气模式能提高HMD患儿的氧合,改善临床转归,降低气胸的发生率,而且不增加颅内出血的发生,疗效明显优于常频通气模式。Objective： To evaluate the effects of high frequency oscillatory ventilation（HFOV） plus synchronized intermittent mandatory ventilation（SIMV） on treating critical hyaline membrane disease（HMD：grade Ⅲ～Ⅳ）.Methods： A total of 53 infants with critical HMD in the NICU of Huaian Maternal and Child Health Hospital from January 2005 to January 2010 were enrolled and divided into two groups： research group（HFOV plus SIMV） and control group（SIMV,or A/C）according the mechanical ventilation mode.X-ray,blood gas analysis,outcome and complications（pneumothorax,intracranial hemorrhage,bronchopulmonary dysplasia） were compared between the two groups.Results： The alteration of X-ray（after 24h treatment）,PO2（after 12 h and 24 h treatment） and outcome in research group were better than control group（all P 〈 0.05）.Compared with control group,the incidence of pneumothorax in research group was significantly lower（P 〈 0.05）.But no statistic significance was found in incidence of intracranial hemorrhage and bronchopulmonary dysplasia between two groups（P 〈 0.05）.Conclusion： HFOV plus SIMV can improve lung oxygenation and the outcome,reduce the incidence rate of pneumothorax without increasing the risk of intracranial hemorrhage.In the treatment of critical HMD,HFOV plus SIMV was superior to conventional mandatory ventilation.

关 键 词：高频振荡通气 常频机械通气 肺透明膜病 早产儿 

分 类 号：R722.12[医药卫生—儿科]