高频振荡通气联合肺泡表面活性物质治疗新生儿ARDS并发气胸的临床研究  

Clinical study of high-frequency oscillatory ventilation combined with pulmonary surfactant in the treatment of neonatal acute respiratory distress syndrome complicated with pneumothorax

作　　者：刘燕 刘诺萱 杜桂梅 崔彦存 杨静 LIU Yan;LIU Nuoxuan;DU Guimei(Department of Neonatology,Hengshui People’s Hospital,Hebei,Hengshui 053000,China)

机构地区：[1]河北省衡水市人民医院新生儿科,053000

出　　处：《河北医药》2024年第17期2618-2621,共4页Hebei Medical Journal

基　　金：河北省卫生健康委员会医学科学研究课题计划(编号:2019-1781)。

摘　　要：目的探讨高频振荡通气(HFOV)联合肺泡表面活性物质(PS)治疗新生儿急性呼吸窘迫综合征(ARDS)并发气胸的临床疗效及其安全性。方法回顾性收集205例新生儿ARDS并发气胸患儿的临床资料,患儿依据治疗方法随机分为3组,HFOV+PS组105例,HFOV组50例、常频机械通气(CMV)+PS组50例。HFOV+PS组患儿予以气管插管、HFOV联合PS混悬液缓慢气管内注入;HFOV组患儿予以气管插管、HFOV治疗;CMV+PS组患儿予以气管插管、常频机械通气联合PS混悬液缓慢气管内注入。记录3组患儿机械通气治疗前、后动脉血气、肺功能指标及气管插管呼吸机通气时间、用氧时间,对比3组观察指标的变化。结果3组患儿机械通气72 h的pH值、PaO_(2)、PaCO_(2)指标差异无统计学意义(P>0.05),HFOV+PS组患儿OI、RI低于HFOV组和CMV+PS组,PaO_(2)/FiO_(2)高于HFOV组和CMV+PS组,差异均有统计学意义(P<0.05)。HFOV+PS组呼吸机通气时间、用氧时间均低于HFOV组和CMV+PS组,且HFOV组低于CMV+PS组,差异均有统计学意义(P<0.05)。3组患儿气管插管呼吸机通气时间、用氧时间比较,HFOV+PS组优于HFOV组和CMV+PS组(P<0.05)。结论HFOV+PS治疗新生儿ARDS并发气胸能更好的改善患儿的肺功能,且利于气胸恢复,提高生存率,临床效果良好。Objective To explore the clinical efficacy and safety of high frequency oscillatory ventilation(HFOV)combined with pulmonary surfactant(PS)in the treatment of newborns with acute respiratory distress syndrome(ARDS)and pneumothorax.Methods Clinical data of 205 newborns with ARDS and pneumothorax were retrospectively collected.The study subjects were randomly divided into three groups according to treatment methods:105 cases in the HFOV+PS group,50 cases in the HFOV group,and 50 cases in the conventional mechanical ventilation(CMV)+PS group.Those in the HFOV+PS group were managed by tracheal intubation,HFOV and slow tracheal injection of PS suspension.Newborns in the HFOV group were treated with tracheal intubation and HFOV.Newborns in the CMV+PS group received tracheal intubation,CMV and slow tracheal injection of PS suspension.Arterial blood gas,lung function indicators,and the ventilation and oxygenation time before and after mechanical ventilation were compared.Results There were no significant differences in the pH level,partial pressure of oxygen(PaO_(2)),and partial pressure of carbon dioxide(PaCO_(2))at 72h among the three groups(P>0.05).Newborns in the HFOV+PS group had significantly lower oxygenation index(OI)and resistance index(RI),and significantly higher PaO_(2)/fraction of inspired oxygen(FiO_(2))than those of HFOV group and CMV+PS group,(P<0.05).Ventilation and oxygenation periods were significantly shorter in the HFOV+PS group than HFOV and CMV+PS groups,which were significantly shorter in the HFOV group than CMV+PS group(P<0.05).Ventilation time and oxygen consumption time of tracheal intubation ventilator were superior in the HFOV+PS group than HFOV and CMV+PS groups(P<0.05).Conclusion HFOV+PS effectively treats neonatal ARDS and pneumothorax,which improves lung function,recovery of pneumothorax,and survival rate with good clinical outcomes.

关 键 词：高频振荡通气 新生儿急性呼吸窘迫综合征 气胸 肺泡表面活性剂 

分 类 号：R725.6[医药卫生—儿科]