肺表面活性物质联合高频震荡通气对新生儿呼吸窘迫综合征的临床疗效

目的：研究肺表面活性物质联合高频震荡通气对新生儿呼吸窘迫综合征的临床疗效。方法选择2012年1月至2016年3月在我院进行诊治的新生儿呼吸窘迫综合征患者82例,分为常频机械通气组(n =41)和高频震荡通气组(n =41)。常频机械通气组采用肺表面活性物质联合常频机械通气治疗,高频震荡通气组采用肺表面活性物质联合高频震荡通气治疗。比较2组患儿治疗前、后的临床症状、血气分析、治愈率、上机时间、住院时间和并发症发生情况。结果治疗前,2组PaCO 2、PaO 2、吸入氧浓度和氧合指数差异无统计学意义(P 值均>0.05),治疗后1、6、12、24 h高频震荡通气组 PaO 2明显高于常频机械通气组(P 值均<0.05),PaCO 2、吸入氧浓度和氧合指数明显低于常频机械通气组(P 值均<0.05);高频震荡通气组住院时间、上机时间和死亡率均明显低于常频机械通气组(P 值均<0.05);2组患儿最主要的并发症为新生儿硬肿症和肺炎,2组的并发症发生率差异无统计学意义(P 值均>0.05)。结论肺表面活性物质联合高频震荡通气能明显改善新生儿呼吸窘迫综合征患儿的血气分析和氧合指数,缩短机械通气治疗时间及住院时间,值得应用推广。     

高频振荡通气在新生儿呼吸窘迫综合征中的应用价值

目的观察高频振荡通气(HFOV)在新生儿呼吸窘迫综合征(NRDS)的应用价值,以及对血气的影响。方法112例NRDS患儿72例应用HFOV治疗为治疗组,40例给予面罩或鼻塞持续气道正压通气(CPAP)吸氧为对照组。观察治疗前及治疗后24h血气分析。结果两组患儿治疗前血气分析比较差异无统计学意义,12h后,治疗组患儿PaO2、pH较对照组上升明显,PaCO2、氧合指数下降明显。结论HFOV治疗NRDS,氧合指数改善快,优于常规治疗。     

机械通气治疗新生儿呼吸窘迫综合征的护理

2002年1月～2003年1月，我们共采用呼吸机机械通气治疗新生儿呼吸窘迫综合征患儿36例，效果满意，现将护理体会报告如下。     

高频振荡通气在成人急性呼吸窘迫综合征的应用

许多临床研究表明高频振荡通气可以改善ARDS患者氧合状态,减少血流动力学并发症和气压伤的产生,成为传统通气治疗失败后的替代治疗.但是,需要进行更深入的研究,进一步明确高频振荡通气在成人ARDS的常规应用.     

高频振荡通气在治疗急性呼吸窘迫综合征中的地位

高频通气是一种高通气频率、低潮气量的通气方式，其通气频率至少为机体常规机械通气的4倍，潮气量接近或小于解剖死腔。主要包括高频正压通气、高频喷射通气、高频射流阻断通气和高频振荡通气。其中高频振荡通气是目前所有高频通气中频率最高的一种（可达15～17Hz），因在治疗重症急性呼吸窘迫综合征（ARDS）具有一定优势，近年来颇受关注。     

高频程序通气在多发伤后急性呼吸窘迫综合征中的应用

目的探讨高频程序通气治疗多发伤后急性呼吸窘迫综合征的效果。方法对60例多发伤引起的急性呼吸窘迫综合征患者进行高频程序通气,观察通气前后动脉血气、血流动力学指标变化。结果治疗24h后氧分压、二氧化碳分压、血氧饱和度较治疗前均明显改善,差异有统计学意义（P〈0．05）;平均动脉压、心率、中心静脉压与通气前相比差异无统计学意义。结论应用高频程序通气能改善多发伤者急性呼吸窘迫综合征氧合状况。     

高频震荡通气治疗先天性心脏病术后重症ARDS32例效果观察

目的探讨高频震荡通气(HFOV)对小儿心脏手术后重症ARDS的治疗效果。方法对32例心脏手术后常频通气(CMV)治疗无效的重症ARDS患儿行HFOV治疗,设置相应的参数并行氧合、通气管理,每次吸痰后行肺复张。观察治疗前后血气指标变化、HFOV治疗时间、肺复张期间循环指标变化、整体治疗期间并发症发生情况及患儿存活情况。结果 HFOV治疗后通气及气体交换在较短的时间内改善,12～48 h血气相关指标PaO2、PaCO2、吸入氧浓度(FiO2)、氧合指数(PaO2/FiO2)均明显改善且稳定。HFOV治疗时间43～238(128.5±67.49)h,肺复张期间循环指标未出现异常变化,末梢血氧饱和度快速恢复至吸痰前水平,呼吸机的吸氧浓度快速降低。整体治疗期间出现气胸9例,均安置胸腔闭式引流。本组患儿存活21例(65.6%),死亡11例。结论 HFOV对CMV治疗无效的重症ARDS能在较短时间内改善通气及气体交换,可作为小儿心脏术后重症ARDS的重要抢救措施。     

经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床研究

目的探讨经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效价值及安全性,以期更好的为临床决策与发展提供相关依据。方法通过运用前瞻性研究方法,对我院自2014年1月-2016年1月期间收治患有呼吸窘迫综合征的120例新生儿随机分组,分别采用经鼻间歇正压通气或经鼻持续气道正压通气(NCPAP)联合肺表面活性物质进行治疗,对两组患儿治疗后的临床疗效加以评价。比较指标包括:氧合指数(OI)、pH值、PaO_2、PaCO_2、治疗成功率、病死率、辅助通气时间及肺漏气率等。结果两组治疗后PaO_2、pH值、OI值均显著升高,PaCO_2显著降低(P0.05)。治疗1 h时:间歇组PaO_2、pH值、OI值均显著高于持续组(P0.05),两组PaCO_2差异无统计学意义(P0.05)。治疗12 h:两组PaO_2、PaCO_2、pH值、OI值差异无统计学意义(P0.05)。另外,NIPPV组的治疗成功率明显高于NCPAP组(P0.05),而NCPAP组的辅助通气时间明显高于NIPPV组(P0.05),病死率、肺气漏比较无明显统计学差异(P0.05)。结论 NIPPV作为一种新型的无创呼吸机械通气技术,治疗效果更优,起效时间更快,治疗成功率更高,在NRDS的治疗中将有着广阔的前景,值得进行推广。     

Efficacy of early piston-type high-frequency oscillatory ventilation in infants with respiratory distress syndrome

We investigated whether the combination of surfactant replacement therapy and early application of high-frequency oscillatory ventilation (HFOV) was more effective in patients with respiratory distress syndrome (RDS) than late application of HFOV and conventional mechanical ventilation (CMV). To determine this, we retrospectively reviewed the cases of 126 neonates with RDS who received surfactant replacement therapy within 4 hr after birth. Patients were grouped into those who received HFOV immediately after birth (HFOV group), those who initially were ventilated by CMV and subsequently received HFOV (CMV/HFOV group), and those who did not receive HFOV (CMV group). Changes in respiratory system compliance (Crs), arterial-alveolar oxygen gradient (a/ApO(2)), and mean airway pressure (MAP) were compared. Infants who received HFOV were less mature than those who received CMV. The a/ApO(2) measured immediately after birth before surfactant replacement therapy was significantly lower in the HFOV and CMV/HFOV group than in the CMV group. After 72 hr, the Crs in the HFOV group was higher than in any other group and was significantly higher than the CMV/HFOV group at 48 and 120 hr. These results suggest that initiating HFOV in combination with surfactant replacement therapy immediately after birth provides effective ventilatory support for infants with RDS.     

Current role of high frequency oscillatory ventilation and airway pressure release ventilation in acute lung injury and acute respiratory distress syndrome

Lung protective ventilatory strategies using conventional ventilators have resulted in decreased mortality in adult patients who have acute lung injury and acute respiratory distress syndrome. Conceptually, high frequency oscillatory ventilation and airway pressure release ventilation appear not only able to fulfill the goals of lung protection, but also to offer some additional advantages over conventional ventilation. Although early data for each of these modes in adults have been encouraging, their widespread use--particularly outside of a rescue situation--cannot be recommended without further evidence.     

高频振荡通气联合蛇毒血凝酶治疗新生儿肺出血的疗效

目的观察高频振荡通气联合蛇毒血凝酶治疗新生儿肺出血的疗效。方法选取我院自2011年12月~2013年12月收治入院的新生儿肺出血患儿67例,随机分为观察组34例及对照组33例,对照组给予常规治疗及高频振荡通气,观察组在对照组的基础上给予蛇毒血凝酶治疗,观察两组患儿的出血停止时间、临床疗效及不良反应。结果观察组与对照组在肺出血停止时间、机械通气时间、住院时间上比较差异具有统计学意义。观察组与对照组在总有效率比较上差异具有统计学意义。结论采用高频振荡通气联合蛇毒血凝酶治疗新生儿肺出血疗效显著,可明显缩短肺出血停止时间、机械通气时间、住院时间,且无明显不良反应。     

新生儿呼吸窘迫综合征的治疗进展

［摘要］　新生儿呼吸窘迫综合征（NRDS）是由肺表面活性物质（PS）缺乏而引起的新生儿早期死亡的危重疾病。近年来对NRDS的治疗取得显著进展,该文概述了NRDS的PS替代疗法、氧疗和体外膜氧合的治疗进展。     

The effect of high-frequency oscillatory ventilator combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

Objective:To investigate the efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS).Methods:This study is a retrospective clinical study. Seventy-two NRDS neonates were selected as the subjects from November 2019 to November 2020, and divided into observation group (40 cases, HFOV treatment) and control group (32 cases, conventional mechanical ventilation treatment). All cases were treated with PS and comprehensive treatment. The therapeutic effect, arterial partial pressure of oxygen (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), Percentage of inhaled oxygen concentration (FiO₂), mean arterialpressure, oxygenation index (OI), and complications were compared in the 2 groups.Results:The total effective rate of the observation group was 90.0%, significantly higher than that of the control group. After treatment, the observation group has higher PaO₂ levels and lower levels of PaCO₂, mean arterial pressure, FiO₂, and OI than the control group. There was no significant difference in the incidence of complications between the 2 groups.Conclusion:HFOV combined with PS has a significant effect on NRDS, which can improve the arterial blood gas index without increasing the incidence of complications.     

经鼻双水平通气在治疗新生儿呼吸窘迫中的作用简

目的 探讨经鼻双水平通气（N-BiPAP）在治疗新生儿呼吸窘迫（RDS）中的作用.方法 对83例RDS新生儿进行分组,观察组接受N-BiPAP治疗,对照组接受经鼻持续正压通气（NCPAP）治疗.结果 T3时两组pH、PaO2及PaO2/ FiO2均明显上升,且PaCO2显著下降,观察组改变程度较对照组更为显著;观察组氧疗时间及住院费用明显低于对照组;观察组死亡1例,并发症率35.7%,对照组死亡3例,并发症率43.9%,两组患儿死亡率及并发症率均无明显统计学差异.结论 经鼻双水平通气可缓解新生儿呼吸窘迫症状,且治疗费用低、安全性好.