高频率和低潮气量在高频振荡通气联合容量保证治疗早产儿呼吸窘迫综合征中的应用研究  

Application of high frequency and low tidal volume in high frequency oscillatory ventilation combined with volume assurance in the treatment of respiratory distress syndrome in premature infants

作　　者：原静[1] 李书芳[2] 张悦哲 孙园园 李艳民[2] 魏燕云 Yuan Jing;Li Shufang;Zhang Yuezhe;Sun Yuanyuan;Li Yanmin;Wei Yanyun(the Second Department of Pediatrics,the First Hospital of Handan,Hebei,Handan 056000,China;Department of Neonatology,the First Hospital of Handan,Hebei,Handan 056000,China;Medical Department,the First Hospital of Handan,Hebei,Handan 056000,China)

机构地区：[1]邯郸市第一医院儿二科,河北邯郸056000 [2]邯郸市第一医院新生儿科,河北邯郸056000 [3]邯郸市第一医院医务科,河北邯郸056000

出　　处：《发育医学电子杂志》2023年第2期112-118,共7页Journal of Developmental Medicine (Electronic Version)

基　　金：河北省医学科学研究重点课题计划(20171112)。

摘　　要：目的探讨在满足充足通气的条件下,高频率+低潮气量策略在高频振荡通气(high frequency oscillation ventilation,HFOV))-容量保证(volume guarantee,VG)治疗新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)早产儿中的应用参数。方法采用回顾性流行病学研究方法。选取2017年2月至2021年4月在邯郸市第一医院住院期间应用HFOV-VG治疗的122例RDS早产儿为研究对象。按呼吸治疗通气频率进行分组:13~14 Hz组(n=7)、15~18 Hz组(n=105)和19~20 Hz组(n=10)。比较3组患儿的一般资料、0 h及24 h的通气指标、通气后24 h的并发症情况。分析RDS患儿的通气频率与潮气量关系的趋势及其相关关系。统计学方法采用单因素方差分析、Kruskal-Wallis秩和检验、χ^(2)检验、趋势χ^(2)检验以及Pearson相关性分析。结果122例患儿中,RDSⅠ级47例(38.5%)、Ⅱ级58例(47.5%)、Ⅲ级15例(12.3%)、Ⅳ级2例(1.6%)。不同通气频率组中,产前未应用糖皮质激素的比例[13~14 Hz组14.3%(1/7);15~18 Hz组19.1%(20/105);19~20 Hz组20.0%(2/10)]比较,差异有统计学意义(χ^(2)=12.288,P<0.05),且随着通气频率的增高,单疗程和未应用的比例增高。产妇及患儿的其他一般资料比较,差异均无统计学意义(P值均>0.05)。不同通气频率组患儿在0 h及24 h的吸入氧浓度(fraction of inspiration O_(2),FiO_(2))、氧合指数(oxygenation index,OI)、平均气道压(mean airway pressure,MAP)、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2))等通气指标比较,差异均无统计学意义(P值均>0.05)。通气后24 h肺炎、败血症、休克、肺出血等并发症的发生率比较,差异均无统计学意义(P值均>0.05)。单因素方差分析显示,不同高通气频率RDS患儿的潮气量的整体差异有统计学意义(F=2.610,P=0.015)。潮气量随通气频率上升呈线性下降趋势(趋势χ^(2)=16.725,P<0.001)。RDS患儿通气频率和潮气量呈负相关(r=-0.296,P=0.001)。结论�Objective To explore the application parameters of high frequency+low tidal volume strategy in the treatment of premature infants with respiratory distress syndrome(RDS)by high frequency oscillation ventilation(HFOV)-volume guarantee(VG)under the condition of sufficient ventilation.Method The method of retrospective epidemiological study was adopted.A total of 122 premature infants with RDS who were treated with HFOV-VG during hospitalization in the First Hospital of Handan from February 2017 to April 2021 were selected as the study objects.The premature infants were divided into 13-14 Hz group(n=7),15-18 Hz group(n=105)and 19-20 Hz group(n=10)according to the ventilation frequency of respiratory therapy.The general data,ventilation indexes at 0 h and 24 h,and complications at 24 h after ventilation were compared among the three groups.The trend and correlation between ventilation frequency and tidal volume in children with RDS were analyzed.The statistical methods performed by one-way ANOVA,Kruskal-Wallis rank sum test,χ^(2) test,trend χ^(2) test and Pearson correlation analysis.Result In the 122 cases,47 cases(38.5%)had RDS grade I,58 cases(47.5%)had RDS grade II,15 cases(12.3%)had RDS grade III,and 2 cases(1.6%)had RDS grade IV.Comparison of the proportion of no antenatal application of glucocorticoids in different ventilation frequency groups[13-14 Hz group 14.3%(1/7),15-18 Hz group 19.1%(20/105),19-20 Hz group 20.0%(2/10)],with statistically significant differences(χ^(2)=12.288,P<0.05),and with the increase of ventilation frequency,the proportion of single treatment and no application increased.There was no statistically significant difference in other general data of maternal and infants(all P>0.05).There was no statistically significant difference in the ventilation indexes of children with different ventilation frequencies at 0 h and 24 h,such as fraction of inspiration O_(2)(FiO_(2)),oxygenation index(OI),mean airway pressure(MAP),and arterial partial pressure of carbon dioxide(PaCO_(2))(all P>0.05).T

关 键 词：高频振荡通气 早产儿 呼吸窘迫综合征 容量保证 潮气量 

分 类 号：R722.1[医药卫生—儿科]