无创高频振荡通气在极低出生体重儿呼吸窘迫综合征拔管撤机后的应用  

Effects of noninvasive high frequency oscillatory ventilation for respiratory distress syndrome in very low birth weight preterm infants after extubation

作　　者：王柱[1] 高薇薇[1] 沈阳 林兴[1] 沈永珍[1] 周文姬[1] 陈佳[1] 许芳[1] 杨杰[1] 唐远平[1] WANG Zhu;GAO Wei - wei;SHEN Yang;LIN Xing;SHEN Yong - zhen;ZHOU Wen - ji;CHEN Jia;XU Fang;YANG Jie;TANG Yuan - ping(Department of Neonatology,Guangdong Women and Children's Hospital,Guangzhou 511400,Guangdong,China)

机构地区：[1]广东省妇幼保健院新生儿科

出　　处：《广东医学》2019年第10期1391-1395,共5页Guangdong Medical Journal

基　　金：广东省医学科研基金立项项目(编号:A2016178)

摘　　要：目的探讨拔管撤机后应用无创高频振荡通气(NHFOV)与经鼻间歇正压通气(NIPPV)治疗极低出生体重呼吸窘迫综合征(RDS)早产儿的临床疗效。方法 103例极低出生体重RDS早产儿依据拔管撤机后呼吸支持治疗方式随机分为NHFOV组(50例)和NIPPV组(53例)。分析两组患儿72 h内撤机成功率、频繁呼吸暂停发生率、无创通气6 h二氧化碳分压(PaCO2)、呼吸支持治疗相关数据及各种并发症的发生率。结果 NHFOV组治疗72 h内撤机成功率高于NIPPV组、无创通气6 h PaCO2低于NIPPV组、无创辅助通气时间短于NIPPV组,差异均有统计学意义(P<0.05);两组频繁呼吸暂停发生率和总用氧时间差异无统计学意义(P>0.05);NHFOV组支气管肺发育不良、脑室周围白质软化、早产儿视网膜病、颅内出血、鼻损伤、气漏并发症的发生率与NIPPV组相比差异均无统计学意义(P>0.05)。结论 NHFOV作为极低出生体重RDS早产儿撤机后呼吸支持模式安全有效,是可供临床选择的另一种无创辅助通气治疗方式,值得临床进一步应用研究。Objective To compare the clinical efficacies of noninvasive high frequency oscillatory ventilation ( NHFOV) and nasal intermittent positive pressure ventilation ( NIPPV) on respiratory distress syndrome ( RDS) among very low birth weight ( VLBW) preterm infants after extubation. Methods A total of 103 VLBW infants with RDS were randomly assigned into NHFOV group ( n = 50) and NIPPV group ( n = 53) according to their respiratory support mode af- ter extubation. The rate of successful extubation within 72 h,the rate of frequent apnea,the level of partial pressure of carbon dioxide ( PaCO2 ) after 6 h noninvasive ventilation,the parameters of respiratory support treatment and the inci- dence of complications were compared between the two groups. Results Compared with NIPPV group,NHFOV group had significantly higher rate of successful extubation within 72 h,lower level of PaCO2,and shorter duration of noninvasive ventilation ( P < 0. 05). There was no significant difference in the rate of frequent apnea or the duration of oxygen therapy between the two groups ( P > 0. 05). There was no significant difference in the incidence rate of bronchopulmonary dyspla- sia,periventricular leukomalacia,retinopathy of prematurity,intracranial hemorrhage,nasal injury or air leak between the two groups ( P > 0. 05). Conclusion NHFOV is a safe and effective as ventilation support for RDS among VLBW pre- term infants after extubation.

关 键 词：呼吸窘迫综合征 无创高频振荡通气 经鼻间歇正压通气 极低出生体重儿 

分 类 号：R722.1[医药卫生—儿科] R722.6[医药卫生—临床医学]