高频振荡通气联合肺泡表面活性物质治疗新生儿急性呼吸窘迫综合征的临床效果  

Clinical effect of high frequency oscillatory ventilation combined with pulmonary surfactant in the treatment of neonatal acute respiratory distress syndrome

作　　者：陈历耋[1] 王淑莲[1] 廖奇[1] 王燎原[1] 邓永红[1] 文波[1] 康艳红 曾艳[1] CHEN Lidie;WANG Shulian;LIAO Qi;WANG Liaoyuan;DENG Yonghong;WEN Bo;KANG Yanhong;ZENG Yan(Department of Neonatology,Loudi Central Hospital,Hunan Province,Loudi 417000,China)

机构地区：[1]湖南省娄底市中心医院新生儿科,湖南娄底417000

出　　处：《妇儿健康导刊》2023年第12期53-56,共4页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

基　　金：娄底市中心医院项目(Y2021-06)。

摘　　要：目的比较高频振荡通气(HFOV)联合肺泡表面活性物质(PS)与常频机械通气(CMV)联合PS治疗新生儿急性呼吸窘迫综合征(NARDS)的效果。方法将2021年6月至2022年6月娄底市中心医院新生儿科收治的40例NARDS采用住院号尾数单双数法将其分为HFOV+PS组和CMV+PS组,每组各20例。记录两组机械通气时间、无创通气及氧疗时间,分别于机械通气前(0 h)及通气后6、12、24、48 h监测患儿动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、PaO_(2)/FiO_(2)、氧合指数(OI),比较并发症发生率及死亡率。结果两组患儿0 h时PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)、OI比较,差异无统计学意义(P>0.05)。随着通气治疗时间的延长,两组患儿PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)及OI均改善,差异有统计学意义(P<0.05)。在通气后6、12、24、48 h两组患儿PaO_(2)、PaCO_(2)、PaO_(2)/FiO_(2)、OI比较,差异有统计学意义(P<0.05)。HFOV+PS组患儿撤机后无创通气及氧疗时间短于对照组,差异有统计学意义(P<0.05)。两组患儿在机械通气时间、肺气漏、肺出血、颅内出血、早产儿视网膜病、支气管肺发育不良、死亡率等方面比较,差异无统计学意义(P>0.05)。结论HFOV+PS、CMV+PS治疗NARDS均能取得较好的疗效,但HFOV联合PS能更快地改善NARDS患儿的氧合,降低二氧化碳潴留,减少撤机后无创通气及氧疗时间,且不增加颅内出血等并发症,值得临床推广。Objective To compare the effect between high frequency oscillatory ventilation(HFOV)combined with pulmonary surfactant(PS)and conventional mechanical ventilation(CMV)combined with PS in the treatment of neonatal acute respiratory distress syndrome(NARDS).Methods A total of 40 cases of NARDS admitted to the Department of Neonatology,Loudi Central Hospital from June 2021 to June 2022 were divided into HFOV+PS group and CMV+PS group using the method of odd or even hospitalization number,with 20 cases in each group.The duration of mechanical ventilation,non-invasive ventilation and oxygen therapy time were recorded in both groups,the children’s arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation(SaO_(2)),PaO_(2)/FiO_(2)and oxygenation index(OI)were monitored before mechanical ventilation(0 h)and 6,12,24 and 48 h after ventilation,respectively,and the incidence of complications and mortality were compared.Results The differences in PaO_(2),PaCO_(2),PaO_(2)/FiO_(2),and OI at 0 h between the two groups were not statistically significant(P>0.05).The PaO_(2),PaCO_(2),PaO_(2)/FiO_(2),and OI improved in both groups as the duration of ventilation treatment increased,with statistically significant differences(P<0.05).There were significant differences in PaO_(2),PaCO_(2),PaO_(2)/FiO_(2),and OI between the two groups at 6,12,24,and 48 h after ventilation(P<0.05).The time of non-invasive ventilation and oxygen therapy in the HFOV+PS group after weaning was shorter than that in the CMV+PS group,and the difference was statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of duration of mechanical ventilation,pulmonary air leak,pulmonary hemorrhage,intracranial hemorrhage,retinopathy of prematurity,broncho-pulmonary dysplasia,and mortality(P>0.05).Conclusion Both HFOV+PS and CMV+PS can achieve good results in the treatment of NARDS,but the former one could improve oxygenation,reduce carbon dioxide retent

关 键 词：高频振荡通气 肺泡表面活性物质 新生儿急性呼吸窘迫综合征 

分 类 号：R722.1[医药卫生—儿科]