高频振荡通气联用一氧化氮吸入在新生儿气胸中的应用  

Application of High Frequency Oscillatory Ventilation Combined with Inhaled Nitric Oxide in Treatment of Neonatal Pneumothorax

作　　者：王玉红[1] 付春花[1] 

机构地区：[1]湖北省妇幼保健院新生儿科,武汉430070

出　　处：《实用儿科临床杂志》2011年第6期433-435,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨高频振荡通气（HFOV）联用一氧化氮（NO）吸入治疗新生儿气胸的疗效。方法选择2003年7月-2008年10月本院新生儿科收治的37例气胸新生儿,均行床边X线胸片,提示肺组织压缩均超过60%,在出现气胸后均接受胸腔闭式引流及机械通气。37例气胸新生儿依治疗方法不同分为2组：HFOV组和HFOV＋NO组。HFOV组17例,在出现气胸后机械通气模式选择HFOV治疗;HFOV＋NO组20例,在给予HFOV治疗的同时吸入NO,吸入NO水平为（5~15）×10-6。2组在治疗2 h、12 h、24 h及以后每24 h行血气分析,并详细记录呼吸机参数,计算氧合指数（OI）,持续监测NO/NO2水平。结果 2组治疗后2 h氧合情况持续改善,OI值、吸入氧浓度（FiO2）、平均呼吸道压均逐渐降低,动脉血氧分压均升高,但HFOV＋NO组较HFOV组改善更显著（Pa〈0.05）。HFOV＋NO组上机时间（88.2±19.8）h,使用FiO2≥0.8时间（5.4±3.5）h;HFOV组上机时间（105.8±22.5）h,使用FiO2≥0.8时间（15.7±8.2）h。2组在上机时间、使用高浓度氧时间方面比较,差异均有统计学意义（Pa〈0.05）。结论 HFOV联用NO吸入治疗新生儿气胸可迅速改善氧合,纠正低氧血症,缩短高浓度氧及呼吸机使用时间,提高抢救成功率。Objective To investigate the clinical effect of high frequency oscillatory ventilation（HFOV） combined with inhaled nitric oxide（NO） in the treatment of neonatal pneumothorax.MethodsThirty-seven neonates with serious pneumothoax were selected from Jul.2003 to Oct.2008,chest X-ray showed that the lung tissue of all the patients were compressed over 60%.The neonates with pneumothorax were managed by mechanical ventilation combined with closed drainage of thoracic cavity.Thirty-seven cases were divided into 2 groups according to different treatment measures,HFOV group（17 cases） were treated with HFOV;HFOV＋NO group（20 cases） were treated with HFOV combined with inhaled NO at a concentration of（5-15）×10-6.Blood gas parameters were measured at treatment 2 h,12 h,24 h respectively,then blood gas was repeated every 24 h,the parameters of mechanical ventilation were recorded,the oxygenation index（OI） was counted in detail,at the same time the concentration of NO/NO2 was monitored continuously.ResultsAfter treatment for 2 hours,the oxygenation was improved,the OI,the fractional inspired oxygen（FiO2）,the mean airway pressure decreased gradually,and the partial pressure of oxygen in arterial blood increased,however the improvement of blood gas in HFOV＋NO group was much better than that in HFOV group（Pa0.05）.The mean time of ventilation in HFOV＋NO group was（88.2±19.8） h,and（105.8±22.5） h in HFOV group.The mean time of inhaling FiO2≥0.8 was（5.4±3.5） h in HFOV＋NO group,and（15.7±8.2） h in HFOV group.There was statistical signi-ficance of mean time of ventilation and meantime of inhaling FiO2≥0.8 between 2 groups（Pa0.05）.ConclusionsThe application of HFOV combined with inhaled NO can improve the oxygenation,reduce the time of ventilation and high oxygen inhaled in the newborns with pneumothorax,the rate of rescue success can increase as well.J Appl Clin Pediatr,2011,26（6）： 433-435

关 键 词：高频振荡通气 一氧化氮 气胸 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]