同步间歇指令通气支持下吸入氦氧混合气和空氧混合气治疗胎粪吸入综合征的随机对照试验  

Randomized controlled trial of inhaling heliox and air oxygen mixture in meconium aspiration syndrom under the support of synchronized intermittent mandatory ventilation

作　　者：马娟[1] 李雪[1] 陈龙[1] 汪丽[1] 赵锦宁[1] 唐仕芳[1] 史源[1] 

机构地区：[1]第三军医大学大坪医院儿科,重庆400042

出　　处：《中国循证儿科杂志》2016年第2期99-103,共5页Chinese Journal of Evidence Based Pediatrics

摘　　要：目的探讨胎粪吸入综合征(MAS)新生儿在同步间歇指令通气(SIMV)支持下吸入氦氧混合气(Heliox)和空氧混合气的疗效。方法 2014年3月1日至2015年5月30日在第三军医大学大坪医院NICU住院的MAS新生儿,以随机数字表法分为Heliox组和对照组,全部患儿均给予SIMV作为呼吸支持模式;Heliox组吸入Heliox 70(He 70%,O_230%)6 h后更换吸入空氧混合气(O_230%);对照组吸入空氧混合气。主要观察指标为治疗期间氧合指数(OI)和拔管时间,次要观察指标为机械通气并发症发生率、NICU住院时间、血气分析、炎症反应指标、心肌损伤标志物、生后28d和100d时振幅整合脑电图(a EEG)结果。结果 Heliox组和对照组分别纳入33和31例。Heliox组OI显著高于对照组,差异有统计学意义(P=0.022),Heliox组拔管时间、机械通气并发症发生率及NICU住院时间均显著低于对照组,差异均有统计学意义(P分别为0.037,0.013和0.010);两组呼吸支持后2、6、12、24、48 h时点血气分析指标(pH、HCO_3-1、BE、PaO_2、PaCO_2)差异均有统计学意义(P均<0.05);Heliox组6h时点炎症反应指标(IL-6、IL-8、TNF-α、CRP)和24 h时点心肌损伤标志物(CK、CK-MB)均较0 h时点降低,差异均有统计学意义(P均<0.05)。Heliox组生后28 d和100d时aEEG检查神经发育重度异常发生率分别为9.1%和3.0%,显著低于对照组的25.8%和9.6%(P<0.05)。结论在SIMV支持下吸入Heliox治疗MAS新生儿较空氧混合气具有良好的疗效,安全性好,值得深入研究。Objective To investigate the curative effect of inhaling heliox and air oxygen mixture in meconium aspiration syndrome under the support of synchronized intermittent mandatory ventilation（SIMV）. Methods Sixty-four children with MAS in NICU of the Da Ping Hospital,Third Military Medical University from March 1st,2014 to May 30 th,2015 were taken as samples. The children,who were treated with SIMV as respiratory support mode,were divided into Helio group（n = 33） and control group（n = 31） in accordance with the random number table. Heliox group inhaled Heliox 70（He 70% O_230%） for 6 h after replacement of inhaling air oxygen mixture（30% O_2）; Control group inhaled air oxygen mixed gas. Main outcome measures： oxygenation index（OI）during treatment and extubation time; Secondary outcome measures： incidence of the complications of mechanical ventilation,hospital stays in NICU, bood gas analysis, inflammation index and myocardial injury markers, amplitude integrated electroencephalography（aEEG） results. Results OI in the heliox group was significantly higher than that in the control group; the difference was statistically significant（P = 0. 022）,and the extubation time,incidence of the complications of mechanical ventilation and hospital stays in NICU of heliox group were significantly lower than those of control group; the differences were statistically significant（P = 0. 037,0. 013 and 0. 010）. Blood gas analysis index（p H,HCO_3-,BE,Pa O_2,Pa CO_2） in two groups（2,6,12,24,48 h） presented some discrepancy; the differences were statistically significant（P〈 0. 05）. The inflammation index（IL-6,IL-8,TNF-a CRP） at 6 h and myocardial injury markers（CK,CK-MB） at 24 h of the two groups were decreased compared with those at 0 h,and heliox group decreased more significantly compared with the control group; the differences were statistically significant（P〈 0. 05）. The a EEG abnormal checking rate of children born after 28 and 100 days of heliox group was 9. 1% and

关 键 词：氦氧混合气 胎粪吸入综合征 新生儿 同步间歇指令通气 

分 类 号：R722.1[医药卫生—儿科]