HFOV对新生儿胎粪吸入综合征气血指标及近期神经行为发育的影响  

Effects of high frequency oscillatory ventilation for neonatal meconium aspiration syndrome on the hemodynamics and short-term neurobehavioral development

作　　者：陈明秋[1] 吴齐爱 张燕飞[1] 黄涌[1] 王章星[1] 童燕梅[1] CHEN Mingqiu;WU Qiai;ZHANG Yanfei;HUANG Yong;WANG Zhangxing;TONG Yanmei(Department of Pediatrics,Longhua New District People's Hospital,Southern Medical University,Shenzhen 518000,China)

机构地区：[1]南方医科大学附属深圳市龙华新区人民医院新生儿科,广东深圳518000

出　　处：《皖南医学院学报》2017年第6期555-558,共4页Journal of Wannan Medical College

摘　　要：目的:探讨高频振荡通气(HFOV)与常频通气(CMV)对新生儿胎粪吸入综合征(MAS)气血指标及近期神经行为发育的影响。方法:选取我院2014年1月~2015年12月收治的120例MAS患儿为研究对象,根据抽签法将患儿分为HFOV组及CMV组各60例,两组于通气后30~60 min采用固尔苏气管滴入治疗,分别于通气2 h、12 h、24 h、48 h记录两组平均动脉压(MAP)、氧合指数(OI)、血氧饱和度(SpO_2)、呼吸末二氧化碳(P_(ET)CO_2)的变化及患儿预后情况。对患儿随访3个月,记录两组患儿近期神经行为发育情况。结果:两组治疗后PaCO_2、PaO_2、SpO_2值较治疗前有改善,且HFOV组治疗后较对照组改善,差异有统计学意义(P<0.05)。HFOV组机械通气时间、住院时间、氧疗时间较CMV组短(P<0.05),HFOV组颅内出血发生率、肺出血率低于CMV组(P<0.05),而两组病死率比较差异无统计学意义(P>0.05)。HFOV组出院后NBNA评分高于CMV组,差异有统计学意义(P<0.05)。结论:HFOV能有效改善MAS患儿缺氧缺血状况,降低患儿颅内出血发生率,促进患儿临床转归,保护患儿神经功能。Objective:To observe the effects of high frequency oscillatory ventilation(HFOV)in treatment of meconium aspiration syndrome(MAS)on the hemodynamics and short term neurobehavioral development in neonates.Methods:120cases of neonatal MAS were included from January2014to December2015,and equally divided into HFOV group and conventional frequency ventilation(CMV)group by random sampling.Curosurf was applied to the neonates in the two groups via tracheal instillation30to60min after ventilation.Indicators,including mean arterial pressure(MAP),oxygenation index(OI),oxygen saturation(SpO2),partial pressure of end tidal carbon dioxide(PETCO2),and prognosis were maintained at2h,12h,24h and48h following ventilation and compared between groups.All neonates were followed for3month for observing the short term neurobehavioral development.Results:PaCO2,PaO2and SpO2values were significantly improved before and after treatment in two groups,and the improvement was better in neonates treated with HFOV(P<0.05).Neonates in HFOV group had shorter time of mechanical ventilation,reduced hospital stay and oxygen therapy,lower incidence of intracranial and pulmonary hemorrhage,yet higher scores on neonatal behavioral neurological assessment(NBNA)than those treated with CMV(all P<0.05).However,the death rate remained no statistical difference(P>0.05).Conclusion:High frequency oscillatory ventilation can effectively improve the cerebral ischemia an anoxia in neonates with MAS,reduce the incidence of intracranial hemorrhage,yet better the clinical outcomes and protect the neonates from neurological damage.

关 键 词：高频振荡通气 新生儿胎粪吸入综合征 气血指标 近期神经行为 

分 类 号：R722.12[医药卫生—儿科]