高频振荡通气模式下肺表面活性物质最佳使用时间选择及对新生儿重度呼吸衰竭转归影响的差异研究  

Study on the optimal use time of pulmonary surfactant under HFOV mode and its effect on the outcome of neonatal severe respiratory failure

作　　者：陈艳江[1] 徐建梅[1] 师麟尧 Chen Yanjiang;Xu Jianmei;Shi Linyao(Department of Neonatal Critical Care Medicine,Shanxi Children's Hospital,Taiyuan 030006,China)

机构地区：[1]山西省儿童医院新生儿重症医学科,山西太原030006

出　　处：《海军医学杂志》2023年第2期182-185,共4页Journal of Navy Medicine

摘　　要：目的探讨高频振荡通气(HFOV)模式下肺表面活性物质最佳使用时间选择及对新生儿重度呼吸衰竭转归影响的差异。方法选择山西省儿童医院2020年1月至2021年12月收治的因新生儿呼吸窘迫综合征发生重度呼吸衰竭新生儿96例,分为出生2 h内给药者的早期组(n=50)和出生2~12 h给药者的晚期组(n=46)。2组均采用HFOV模式下肺表面活性物质给药,分别于治疗前(T_(0))及治疗后1 h(T_(1))、12 h(T_(2))、24 h(T_(3))记录2组血气分析指标氧分压(PaO_(2))、二氧化碳分压(Pa-CO_(2))、血氧饱和度(SaO_(2))、动脉肺泡氧分压比(a/A)、pH值和氧合指数(OI=PaO_(2)/FiO_(2)),观察2组并发症发生情况以及通气时间、用氧时间、住院时间、住院费用及死亡率。结果随着治疗后时间的不断增加,2组PaO_(2)、a/A、SaO_(2)、pH值随之升高,Pa-CO_(2)、OI随之降低,且早期组升高和降低的幅度均大于晚期组;早期组患儿并发症总发生率22.00%,低于晚期组的41.30%(P<0.05);早期组患儿通气时间、用氧时间、住院时间均短于晚期组(P<0.05),住院费用少于晚期组(P<0.05);2组患儿死亡率比较差异无统计学意义(P>0.05)。结论HFOV模式下肺表面活性物质在出生2h内给药可有效改善患儿的血气分析指标,降低并发症的发生率,缩短通气、用氧以及住院时间,减少住院费用,降低死亡率。Objective To investigate the optimal use time of pulmonary surfactant under high frequency oscillatory ventilation(HFOV)mode and its effect on the prognosis of neonatal severe respiratory failure.Methods 96 newborns with severe respiratory failure due to neonatal respiratory distress syndrome treated in the hospital from January 2020 to December 2021 were selected as study subjects,and were divided into the early medication group(n=50)within 2 hours after birth and the late medication group(n=46)within 2−12 hours after birth.Both groups were given pulmonary surfactant under HFOV mode.Such blood gas analysis indexes as oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),blood oxygen saturation(SaO_(2)),arterial alveolar oxygen partial pressure ratio(a/A),pH value and oxygenation index(OI=PaO_(2)/FiO_(2))before treatment(T_(0)),1 hour(T_(1)),12 hours(T_(2))and 24 hours(T_(3))after treatment were redorded in the 2 groups.The rates of complications,ventilation,oxygen comsumption,length of hospital stay,hospitalization costs and mortality of the two groups were observed closely.Results With the increase of treatment time,the PaO_(2),a/A,SaO_(2) and pH values of the two groups increased,and the PaCO_(2) and OI decreased,with the increase and decrease rates of the early group being greater than those of the late group.The total complication rate of the early group was 22.00%,which was lower than that of the late group(41.30%)(P<0.05);The ventilation time,oxygen inhalation time and hospitalization time of the children in the early group were shorter than those in the late group(P<0.05),and the hospitalization cost of the former was less than that in the latter(P<0.05).There was no statistical significance in mortality,when comparisons were made between the two groups(P>0.05).Conclusion The application of pulmonary surfactant within 2 hours after birth in HFOV mode could effectively improve the blood gas analysis indexes of neonates,reduce the rate of complications,shorten oxygen ventilation and h

关 键 词：高频振荡通气 肺表面活性物质 新生儿 重度呼吸衰竭 并发症 死亡 

分 类 号：R722.1[医药卫生—儿科]