同步间歇指令通气与高频震荡通气治疗新生儿呼吸窘迫综合征的疗效

目的：评价同步间歇指令通气（SIMV）和高频震荡通气（HFOV）治疗新生儿呼吸窘迫综合征（NRDS）的疗效及安全性。方法符合纳入标准的NRDS患儿，随机分为SIMV组和HFOV组，记录两组血气值和呼吸机参数的变化，观察两组的临床疗效及支气管肺发育不良（BPD）、肺气漏（PAL）、Ⅲ～Ⅳ级颅内出血（IVH）、脑室周围白质软化（PVL）等并发症的发生率。结果最终完成试验SIMV组25例，HFOV组23例。 HFOV组改善氧合更明显，6、24小时HFOV组吸入氧浓度、氧合指数与SIMV组比较差异有统计学意义（P＜0．05），PaCO2、存活率差异无统计学意义（P＞0．05），两组BPD、PAL、IVH、PVL等并发症发生率比较差异均无统计学意义（P＞0．05），两组机械通气时间及住院时间比较差异有统计学意义（P＜0．05）。结论 SIMV和HFOV治疗NRDS是安全有效的，HFOV的优势是能迅速改善氧合，缩短上机时间。

Curative effect of high frequency oscillatory ventilation versus synchronized intermittent mandatory ventilation in preterm infants with neonatal respiratory distress syndrome

Objective To evaluate the efficacy and safety of high frequency oscillatory ventilation （HFOV） and synchronized inter-mittent mandatory ventilation （ SIMV） in preterm infants with neonatal respiratory distress syndrome （ NRDS） requiring ventilation .Methods Preterm infants with NRDS requiring ventilation were randomly assigned to receive SIMV or HFOV .Blood gas values ,respiratory parameter , clinical efficacy,and incidence of mechanical ventilation complications such as bronchopulmonary dysplasia （ BPD）,pulmonary air leakage （PAL）,and serious brain injury and so on were compared between two groups .Results Twenty -three patients received HFOV and 25 SIMV.HFOV group demonstrated better early oxygenation .Significant differences were found between the two groups in oxygenation index （OI）,and FiO2 at 6 and 24 hour（P〈0.01）.Mean PaCO2 in HFOV and SIMV group was not significantly different .No significant difference was found between the two groups in the incidences of BPD ,PAL and serious brain injury（P〉0.05）.The complication rate and survival rate were similar in two groups.The ventilation time and hospitalization time in SIMV were significantly longer than those in HFOV （P〈0.05）. Conclusion It is efficient and safe for the treatment of NRDS with HFOV or SIMV .HFOV can improve oxygenation rapidly and decrease ventilation time and hospitalization time .