不同通气模式对新生儿呼吸窘迫综合征患儿临床康复的影响  

Influence of different breathing patterns on clinical rehabilitation in neonatal respiratory distress syndrome

作　　者：邱其周[1] 程贵辉[1] 陈虹余[1] 熊伟[1] 刘仁红[1] 肖毅[1] 

机构地区：[1]广州医科大学附属深圳沙井医院新生儿科,518104

出　　处：《中华妇幼临床医学杂志（电子版）》2016年第2期206-210,共5页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：深圳市宝安区科技局资助项目(2015205)~~

摘　　要：目的探讨鼻塞持续气道正压通气(NCPAP)、常频机械通气(CMV)及高频振荡通气(HFOV)3种通气模式联合肺表面活性物质(PS)对新生儿呼吸窘迫合征(NRDS)患儿临床康复的影响。方法选取2011年1月至2015年5月广州医科大学附属深圳沙井医院收治的151例NRDS患儿为研究对象。按照不同通气模式,将151例NRDS患儿分为NCPAP组(n=55)、CMV组(n=48)、HFOV组(n=48),3组患儿除采用不同通气模式外,均给予维持内环境、营养支持等综合治疗。3组患儿在出生胎龄、分娩方式、出生体重、NRDS分级等方面比较,差异均无统计学意义(P>0.05)。统计学比较3组患儿血气分析变化、辅助通气时间、住院时间、氧疗时间及气胸、呼吸机相关性肺炎(VAP)、支气管肺发育不良(BPD)发生率的差异。本研究遵循的程序符合广州医科大学附属深圳沙井医院人体试验委员会制定的伦理学标准,得到该委员会批准,并征得受试对象监护人的知情同意。结果 13组患儿治疗前、治疗后2、12、24、72h血气分析的pH值、动脉血氧分压(PaO_2)、动脉二氧化碳分压(PaCO2)分别整体比较,差异均有统计学意义(P=0.000)。2NCPAP组、CMV组和HFOV组间辅助通气时间、住院时间、氧疗时间及气胸、VAP、BPD发生率比较,差异均有统计学意义(P<0.05)。NCPAP组VAP、BPD发生率、辅助通气时间、住院时间及氧疗时间,均显著低于CMV组与HFOV组,差异均有统计学意义(P<0.05),CMV组气胸发生率与NCPAP组及HFOV组比较,差异均有统计学意义(P<0.05);NCPAP组与HFOV组气胸发生率比较,差异无统计学意义(P>0.05)。结论 NCPAP治疗NRDS疗效肯定,并可有效降低并发症发生率,减少辅助通气时间、住院时间及氧疗时间,值得基层医院临床推广应用。Objective To observe the influence of nasal continuous positive airway pressure （NCPAP）, conventional mechanical ventilation （CMV） and high-frequency oscillatory ventilation （HFOV） combined with pulmonary surfactant （PS） in the treatment of neonatal respiratory distress syndrome （NRDS）. Methods From January 2011 to May 2015, a total of 151 cases with NRDS who were admitted to Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University were included into this study. They were randomly divided into NCPAP group （n = 55）, CMV group （n= 48） and HFOV group （n = 48） according to different breathing patterns. The three groups accepted PS replacement treatment and corresponding conventional treatment. There were no significant differences among three groups in the aspects of gestational age, delivery modes, birth weight, NRDS classfication （P 〉 0.05）. The blood gas analysis results, duration of assisted ventilation, hospitalization, duration of oxygen therapy and the incidence of pneumothorax, ventilator associated pneumonia （VAP） and bronchopulmonary dysplasia （BPD） were compared among three groups by statistic methods. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University. Informed consent was obtained from each partieipaters parents. Results There were significant differences of pH value, pertial pressure of oxygen in artery （Paoz ） and partial pressure of carbon dioxide （Paco2 ） at different time points （before the treatment, 2, 12, 24 and 72 h after the treatment） among three groups. There were significant differences among three groups in the aspects of duration of assisted ventilation, hospitalization, duration of oxygen therapy and the incidence of pneumothorax, VAP and BPD （P〈0. 05）. The incidence of VAP, BPD, duration of assisted ventilation, hospitalization, duration of oxygen therapy of NCPAP group were lower than those of CMV

关 键 词：呼吸窘迫综合征 新生儿 连续气道正压通气 常频机械通气 高频通气 

分 类 号：R722.1[医药卫生—儿科]