高频振荡通气加常频通气治疗早产儿肺透明膜病的临床和护理研究

目的研究高频振荡通气加常频通气治疗早产儿肺透明膜病的临床疗效和护理特点。方法以2009年1月～2010年12月在本院新生儿重症监护室（NICU）住院采用机械通气治疗的18例早产儿肺透明膜病（HMD）患儿为研究对象,随机分为研究组10例和对照组8例,研究组通气模式为高频振荡通气加常频通气,对照组采用为常频通气模式,比较两组患儿匕机后临床疗效、呼吸机参数、氧合指标以及气胸、颅内出血等并发症的发生率,同时总结高频振荡通气加常频通气的护理特点和体会。结果研究组上机24h后吸氧浓度（FiO2）、平均气道压力（MAP）、氧合指数（0I）和临床转归均优于对照组（P〈0．05）;研究组气胸发生率低于对照组（P〈0．05）;颅内出血发生率两者无显著性差异（P〉0．05）。结论高频叠加常频通气模式能提高HMD患儿的氧合,改善临床转归,降低气胸的发生率,而且不增加颅内出血的发生,疗效明显优于常频通气模式。同时治疗过程中优质的机械通气相关护理配合是抢救成功的重要因素。     

高频振荡通气治疗早产儿肺透明膜病的临床效果

目的 探究高频振荡通气治疗早产儿肺透明膜病的临床效果。方法 2020 年 4 月至 2021 年 12 月我院 68 例患有肺透明膜 病早产患随机分为对照组和观察组，每组各 34 例。对照组实施常频通气治疗方案。观察组采用高频振荡通气治疗方案。比较 两组的血气指标、撤机时间、并发症发生率。结果 观察组血气指标、撤机时间、并发症发生率优于对照组（P<0.05）。结论 高 频振荡通气治疗早产儿肺透明膜病可有效改善患儿的血气指标，缩短机械通气治疗时间与住院时间，减少患儿的并发症。     

情景模拟演练联合翻转课堂模式对急诊护理实习生考核成绩及急救技能水平的影响

目的：探究在早产儿肺透明膜病的治疗中应用高频振荡通气对改善患儿血气指标所发挥的作用,并总结临床护理要点。方法：抽取68例患有肺透明膜病早产患儿纳入治疗内,均分为观察组及对照组,每组是34例。观察组采用高频振荡通气治疗方案,对照组实施常频通气治疗方案。在治疗期间均实施综合护理干预,对比两组患儿治疗前、后的血气指标、撤机时间、并发症发生率。结果：经治疗与护理,观察组患儿的血气指标数据明显优于对照组,治疗时间短,并发症发生率低,几项指标数据形成组间对比,P<0.05。结论：高频振荡通气治疗早产儿肺透明膜病可有效改善患儿的血气指标,缩短机械通气治疗时间与住院时间,并发症少。在治疗期间实施综合护理干预可提升疗效,建议应用。     

INSURE策略治疗新生儿肺透明膜病的临床疗效观察

目的探讨应用气管插管-使用肺表面活性物质-拔管使用鼻塞式气道正压通气（NCPAP）即INSURE策略治疗新生儿肺透明膜病（HMD）的有效性及安全性。方法将2011年5月至2013年5月收治的HMD并同意使用PS的71例患儿随机分为INSURE策略治疗（观察组）36例和常频通气（CMV）治疗（对照组）35例。比较两组患儿肺功能、呼吸机上机时间、氧疗时间、并发症及转归。结果治疗48h后观察组氧合指数较对照组明显增高,差异有统计学意义（P〈0．01）。观察组与对照组PaCO2、上机时间差异均无统计学意义（P均〉0．05）,但观察组氧疗时间较对照组明显缩短（P〈0．01）,相关性肺炎发生率较对照组稍降低,但差异无统计学意义（P〉0．05）。结论INSURE策略能更好地改善HMD患儿氧合功能、缩短氧疗时间,具有很好的临床疗效及安全性。     

高频震荡通气联合肺表面活性物质治疗重症胎粪吸入综合征的疗效

目的探讨高频震荡通气联合气管滴人肺表面活性物质（固尔苏）治疗重症胎粪吸人综合征（MAS）的疗效。方法将30例重症胎粪吸人综合征患儿按随机数字表法分为观察组和对照组,每组15例。对照组采用常频通气联合气管滴入肺表面活性物质治疗;观察组采用高频震荡通气联合气管滴入肺表面活性物质治疗。对2组患儿疗效,‰O：、p桕：,吸人氧浓度（FiO：）和氧合指数（OI）的变化,机械通气时间及住院时间进行比较。结果观察组机械通气时间及住院时间明显低于对照组（均P〈0．05）;随着治疗时间的增加,观察组的Pa02、Pa02／FiO2和0I均明显优于对照组f均P〈0．05）。结论高频震荡通气联合早期应用肺表面活性物质,能减轻炎症反应,有利于重症胎粪吸入综合征患儿的治疗。     

允许性高碳酸血症通气法治疗呼吸窘迫综合征

目的：探讨允许性高碳酸血症通气法在治疗呼吸窘迫综合征中的价值。方法：随机选择46例需机械通气治疗的呼吸窘迫综合征患儿分为两组，对照组以传统通气方式治疗；允许性高碳酸血症通气法（治疗组）调节吸气峰压、呼气末压力、平均气道压等通气条件，维持血气PaCO2在45～55mmHg。比较两组通气条件、通气过程中血气值、并发症发生率和．病死率。结果：两组在通气过程中，氧舍指数（PaO2／FiO2）、pH值7LPaO2差异无显著性（P〉0．05），PaCO2差异有显著性（P〈0．01），允许性高碳酸血症通气法组上机时间显著减少（P〈0．05），气漏等并发症发生率明显降低．可降低病死率。结论：允许性高碳酸血症通气法在呼吸窘迫综合征治疗中较传统通气方式能降低并发症的发生率和缩短通气时间。     

高频振荡通气在早产儿合并重症肺透明膜病呼吸支持中应用

目的探讨高频振荡通气在早产儿合并重症肺透明膜病呼吸支持中的应用。方法回顾分析2008年2月至2010年2月我科95例早产儿合并重症肺透明膜病。结果本组95例早产儿合并重症肺透明膜病患儿经高频振荡通气、综合治疗。治愈72例;死亡15例,放弃治疗8例。结论本组结果表明,在对早产儿合并重症肺透明膜病患儿采取高频振荡通气进行呼吸支持,取得良好的效果,治疗中应严格掌握临床适应证,应用合理的通气方式,可减少患儿的病死率。     

产前应用地塞米松预防早产儿肺透明膜病的临床分析

目的探讨产前应用塞米松对预防早产儿肺透明膜病（HMD）的作用，以及其对产妇产后感染的影响。方法分析我院2003年2月至2007年10月住院的妊娠小于36周先兆早产孕妇共216例，其中治疗组产前应用地塞米松预防HMD116例，对照组未予地塞米松预防HMD100例，比较两组早产儿HMD发生率，死亡率，HMD患儿机械通气时间，临床治愈时间，以及产妇产褥病率。结果治疗组HMD发生率11．21％，死亡率0．86％，与对照组发生率29％，死亡率8％比较有差异有统计学意义（P〈0．01）；治疗组HMD患儿机械通气时间（50．56±12．83）h，临床治愈时间（7．06±1．34）d，与对照组机械通气时间（85．41±19．79）h，临床治愈时间（9．27±2．65）d比较亦有差异有统计学意义（P〈0．01；〈0．05），而两组产妇产褥病率比较无显著性差异（P〉0．05）。结论产前应用地塞米松预防早产儿HMD疗效显著，可减少HMD发生率，死亡率，减少机械通气时间及临床治愈时间，但并没有增加产褥病率的风险。     

鼻塞法持续呼吸道正压通气防治新生儿肺透明膜病的监护

目的：探讨鼻塞法持续呼吸道正压通气（NCPAP）在防治新生儿肺透明膜病的应用及护理。方法：60例胎龄29～35周的早产儿随机分为两组，观察组（30例）生后即给以NCPAP，对照组（30例）生后即给以鼻导管前庭吸氧，观察生命体征、血气指标变化。结果：观察组的各项指标比较稳定优于对照组，差异有显著性（P〈0．05）。观察组总有效率93．33％，对照组总有效率66．67％，差异有高度显著性（P〈0．01）。结论：NCPAP防治新生儿肺透明膜病效果显著且安全。     

高频振荡通气联合肺表面活性物质治疗新生儿胎粪吸入综合征效果分析

目的观察高频振荡通气联合肺表面活性物质对新生儿胎粪吸入综合征的治疗效果。方法回顾性分析59例胎粪吸入综合征新生儿的临床资料,根据治疗方式的不同将患儿分为观察组33例与对照组26例,观察组在常规治疗基础上采用高频振荡通气联合肺表面活性物质治疗,对照组在常规治疗基础上采用高频振荡通气治疗,比较2组患儿治疗前后氧合指标变化情况和治疗后临床指标改善时间、并发症发生情况。结果治疗后,2组动脉血二氧化碳分压[pa(CO_2)]、氧合指数(OI)及吸入气中的氧浓度分数(FiO_2)均低于治疗前,动脉血氧分压[pa(O_2)]高于治疗前,且观察组pa(CO_2)、OI及FiO_2均低于对照组,pa(O_2)高于对照组,差异有统计学意义(P 0.05);观察组呼吸机治疗时间、住院时间均短于对照组,差异有统计学意义(P 0.05);观察组并发症发生率低于对照组,差异有统计学意义(P 0.05)。结论采用高频振荡通气联合肺表面活性物质治疗新生儿胎粪吸入综合征,可有效改善患儿氧合指数,缩短住院时间,降低并发症发生率,提高治疗效果。     

肺表面活性物质与机械通气联合治疗肺透明膜病的疗效评价

新生儿呼吸窘迫综合征(NRDS)又称肺透明膜病(HMD),是早产儿常见病及主要死亡原因之一。肺表面活性物质(PS)替代疗法是治疗本病的特效治疗手段。目前国内外有条件的医院已广泛应用外源性PS治疗HMD,均取得成功,明显的降低了死亡率[1,2]。由于PS价格昂贵,绝大多数基层医院尚未开展     

Lung-protective ventilation strategies in neonatology: what do we know--what do we need to know?

OBJECTIVE: Randomized controlled trials (RCTs) investigating various lung-protective ventilation modes or strategies in newborn infants have failed to show clear differences in mortality or bronchopulmonary dysplasia. This review tries to identify possible reasons for this observation, applying modern concepts on ventilator-induced lung injury and lung-protective ventilation. DATA SOURCE: Published RCTs and systematic reviews on mechanical ventilation in newborn infants were identified by searching PubMed and the Cochrane Library. DATA SYNTHESIS: A total of 16 RCTs and four systematic reviews comparing high-frequency ventilation with conventional mechanical ventilation (CMV) failed to show consistent differences in mortality and bronchopulmonary dysplasia. Unfortunately, clear information or data on ventilation and oxygenation targets in the search for optimal lung volumes during high-frequency ventilation or CMV is lacking in many RCTs, questioning the validity of the results and the meta-analytic subgroup analysis. Based on improvement in oxygenation, only three RCTs successfully applied the optimal lung volume strategy during high-frequency ventilation. A total of 24 RCTs and three systematic reviews comparing various CMV modes and settings and two RCTs investigating permissive hypercapnia reported no differences in mortality or bronchopulmonary dysplasia. However, the intervention arms in these RCTs did not differ in tidal volume or positive end-expiratory pressures, variables that are considered important determinants in ventilator-induced lung injury. In fact, no RCT in newborn infants has substantiated so far the experimental finding that avoiding large tidal volumes and low positive end-expiratory pressure during CMV is lung protective in newborn infants. CONCLUSION: RCTs investigating lung-protective ventilation in neonates have mainly focused on comparing high-frequency ventilation with CMV. Most of these RCTs show weaknesses in the design, which may explain the inconsistent effect of high-frequency ventilation on bronchopulmonary dysplasia. RCTs on CMV only focused on comparing various modes and settings, leaving the important question whether reducing tidal volume or increasing positive end-expiratory pressure is also lung protective in newborn infants unanswered.     

Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn

OBJECTIVE: We previously reported improved oxygenation, but no change, in rates of extracorporeal membrane oxygenation (ECMO) use or death among infants with persistent pulmonary hypertension of the newborn who received inhaled nitric oxide (NO) with conventional ventilation, irrespective of lung disease. The goal of our study was to determine whether treatment with inhaled NO improves oxygenation and clinical outcomes in infants with persistent pulmonary hypertension of the newborn and associated lung disease who are ventilated with high-frequency oscillatory ventilation (HFOV). DESIGN: Single-center, prospective, randomized, controlled trial. SETTING: Newborn intensive care unit of a tertiary care teaching hospital. PATIENTS: We studied infants with a gestational age of > or =34 wks who were receiving mechanical ventilatory support and had echocardiographic and clinical evidence of pulmonary hypertension and hypoxemia (PaO2 < or =100 mm Hg on FIO2 = 1.0), despite optimal medical management Infants with congenital heart disease, diaphragmatic hernia, or other major anomalies were excluded. INTERVENTIONS: The treatment group received inhaled NO, whereas the control group did not. Adjunct therapies and ECMO criteria were the same in the two groups of patients. Investigators and clinicians were not masked as to treatment assignment, and no crossover of patients was permitted. MEASUREMENTS AND MAIN RESULTS: Primary outcome variables were mortality and use of ECMO. Secondary outcomes included change in oxygenation and duration of mechanical ventilatory support and supplemental oxygen therapy. Forty-two patients were enrolled. Baseline oxygenation and clinical characteristics were similar in the two groups of patients. Infants in the inhaled NO group (n = 21) had improved measures of oxygenation at 15 mins and 1 hr after enrollment compared with infants in the control group (n = 20). Fewer infants in the inhaled NO group compared with the control group were treated with ECMO (14% vs. 55%, respectively; p = .007). Mortality did not differ with treatment assignment. CONCLUSIONS: Among infants ventilated by HFOV, those receiving inhaled NO had a reduced need for ECMO. We speculate that HFOV enhances the effectiveness of inhaled NO treatment in infants with persistent pulmonary hypertension of the newborn and associated lung disease.     

Frequency of chronic lung disease in infants with severe respiratory failure treated with high-frequency ventilation and/or extracorporeal membrane oxygenation.

OBJECTIVE: To assess the frequency of chronic lung disease and factors associated with its development in term infants with severe respiratory failure who receive high-frequency oscillatory ventilation, or high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective review of pulmonary outcome of all ECMO candidates admitted to Wilford Hall USAF Medical Center between July 1985 and September 1989. SETTING: A tertiary, level III, neonatal ICU accepting regional referrals for high-frequency ventilation and ECMO. PATIENTS: Ninety-four patients who were candidates for ECMO were studied. High-frequency oscillatory ventilation alone was used in 48 infants. Forty-six infants were treated with high-frequency oscillatory ventilation and ECMO. MAIN RESULTS: Twenty (24%) of 84 survivors developed chronic lung disease. There were no differences in gestational age, birth weight, or gender between those infants who developed chronic lung disease and those infants who did not. Arterial blood gas and ventilatory settings at initiation of high-frequency oscillatory ventilation were similar between those infants who did and those who did not develop chronic disease. Patients who developed chronic lung disease more often had lung hypoplasia (40% vs. 5%) and more often required ECMO (75% vs. 39%) than those patients who did not. In patients without lung hypoplasia, those patients who developed chronic lung disease were older at initiation of high-frequency oscillatory ventilation rescue than those patients who did not develop chronic lung disease (median 91 vs. 46 hrs). CONCLUSIONS: The frequency of chronic lung disease in ECMO candidates is clinically important. Factors associated with chronic lung disease in ECMO candidates are: the presence of lung hypoplasia, delayed referral, and the need for ECMO to support gas exchange.     

固尔苏在肺透明膜病患儿中的应用及护理

目的 探讨固尔苏治疗肺透明膜病患儿的效果和护理方法.方法 选择2008年6月至2010年6月新生儿病房收治的肺透明膜病患儿56例,将其随机分为对照组26例和治疗组30例.对照组单用机械通气治疗及相应常规护理,治疗组在此基础上联合固尔苏治疗及系统的护理干预.观察2组患儿症状缓解时间、机械通气时间、住院时间、并发症发生率、死亡率以及治疗前后PaO2和PaCO2.结果 治疗组症状缓解时间、机械通气时间、住院时间、并发症发生率均明显低于对照组;治疗组PaO2和PaCO2改善情况明显优于对照组.结论 对肺透明膜病患儿尽早应用固尔苏和系统的护理干预,能快速改善缺氧症状,有效减少并发症,降低病死率,加速疾病的治愈.

Abstract：

Objective To investigate the effect of curosurf in treatment of children with hyaline membrane disease and the nursing. Methods 56 cases of children patients with hyaline membrane disease from June 2008 to June 2010 admitted to neonatal wards were selected. The control group (26 cases)treated with mechanical ventilation alone and corresponding conventional care, on this basis, the treatment group (30 cases) was treated with curosurf and give systemic nursing intervention. Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate, death rate, PaO2 and PaCO2 before and after treatment were observed in two groups. Results Symptomatic relief time, mechanical ventilation time, length of stay, complication incidence rate in the treatment group was significantly lower than that in the control group; PaO2 and PaCO2 amelioration in the treatment group was better than the control group. Conclusions Children with hyaline membrane disease should be treated with curosurf and given systemic nursing intervention as early as possible, it can rapidly improve the symptoms of hypoxia, reduce complications, decrease mortality, accelerate the recovery of disease.     

High-frequency oscillatory lung ventilation in complex therapy for congenital pneumonia and hyaline membrane disease in newborns

Fifty-eight neonatal infants with hyaline membrane disease (HMD) and congenital pneumonia were examined in the critical status. In 32 of them, high-frequency oscillatory lung ventilation (HFOLV) was employed. The use of HFOLV was found to reduce the length of stay in neonates on toxic oxygen concentrations by more than 2 times and to accelerate the normalization of ventilation-perfusion relationships by more than 3 times. A study of the basic parameters of central and regional hemodynamics showed that HFOLV failed to affect the patients' hemodynamic status. The efficiency of correction of severe respiratory disorders in neonatal infants with HMD was ascertained to increase with the combined use of the Russian surfactant and HFOLV. A formula was developed to calculate the starting amplitude of oscillations when HFOLV was employed. The maximum allowable values of mean airway pressure at which HFOLV could be discontinued were determined, which prevented the regimens from toughening when HFOLV was changed to the routine artificial ventilation. The use of HFOLV was established to reduce the risk of severe cerebral structural and vascular lesions and mortality rates.     

Uneven distribution of ventilation in acute respiratory distress syndrome

As in the adult with acute lung injury and acute respiratory distress syndrome, the use of lung-protective ventilation has improved outcomes for neonatal lung diseases. Animal models of neonatal respiratory distress syndrome and congenital diaphragmatic hernia have provided evidence that 'gentle ventilation' with low tidal volumes and 'open-lung' strategies of using positive end-expiratory pressure or high-frequency oscillatory ventilation result in less lung injury than do the traditional modes of mechanical ventilation with high inflating pressures and volumes. Although findings of retrospective studies in infants with respiratory distress syndrome, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn have been similar to those of the animal studies, prospective, randomized, controlled trials have yielded conflicting results. Successful clinical trial design in these infants and in children with acute lung injury/acute respiratory distress syndrome will require an appreciation of the data supporting the modern ventilator management strategies for infants with lung disease.     

Bench-to-bedside review: Ventilator strategies to reduce lung injury – lessons from pediatric and neonatal intensive care

As in the adult with acute lung injury and acute respiratory distress syndrome, the use of lung-protective ventilation has improved outcomes for neonatal lung diseases. Animal models of neonatal respiratory distress syndrome and congenital diaphragmatic hernia have provided evidence that 'gentle ventilation' with low tidal volumes and 'open-lung' strategies of using positive end-expiratory pressure or high-frequency oscillatory ventilation result in less lung injury than do the traditional modes of mechanical ventilation with high inflating pressures and volumes. Although findings of retrospective studies in infants with respiratory distress syndrome, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn have been similar to those of the animal studies, prospective, randomized, controlled trials have yielded conflicting results. Successful clinical trial design in these infants and in children with acute lung injury/acute respiratory distress syndrome will require an appreciation of the data supporting the modern ventilator management strategies for infants with lung disease.     

Invasive and noninvasive neonatal mechanical ventilation

Neonatal respiratory failure consists of several different disease entities, with different pathophysiologies. During the past 30 years technological advances have drastically altered both the diagnostic and therapeutic approaches to newborns requiring mechanical assistance. Treatments have become both patient- and disease-specific. The clinician has numerous choices among the noninvasive and invasive ventilatory treatments that are currently in use. This article reviews the pathophysiology of respiratory failure in the newborn and the available methods to treat it, including continuous positive airway pressure, conventional and high-frequency mechanical ventilation, extracorporeal membrane oxygenation, and styles of ventilation and monitoring.     

Bench-to-bedside review: Ventilator strategies to reduce lung injury -- lessons from pediatric and neonatal intensive care

As in the adult with acute lung injury and acute respiratory distress syndrome, the use of lung-protective ventilation has improved outcomes for neonatal lung diseases. Animal models of neonatal respiratory distress syndrome and congenital diaphragmatic hernia have provided evidence that 'gentle ventilation' with low tidal volumes and 'open-lung' strategies of using positive end-expiratory pressure or high-frequency oscillatory ventilation result in less lung injury than do the traditional modes of mechanical ventilation with high inflating pressures and volumes. Although findings of retrospective studies in infants with respiratory distress syndrome, congenital diaphragmatic hernia, and persistent pulmonary hypertension of the newborn have been similar to those of the animal studies, prospective, randomized, controlled trials have yielded conflicting results. Successful clinical trial design in these infants and in children with acute lung injury/acute respiratory distress syndrome will require an appreciation of the data supporting the modern ventilator management strategies for infants with lung disease.