无创高频通气治疗新生儿呼吸窘迫综合征临床疗效分析

目的:探讨使用无创高频振荡通气和CPAP通气模式治疗新生儿呼吸窘迫综合征,比较二者治疗效果及并发症发生率,是否可减少上机时间及住院天数等。方法:选择河南省周口市中心医院新生儿重症监护病房(NICU)2016-03—2018-03期间收治的RDS患儿74例,分为无创高频组(NHFV组)36例及无创正压通气组(NCPAP组)38例,比较两组上机前和上机后12、24、48、72h动脉血气变化、并发症发生情况、上机时间等。结果:NHFV组PO_2、a/APO_2、SaO_2在给予呼吸支持后12、24、48、72h均高于NCPAP组,差异均有统计学意义(均P0.05);NHFV组PaCO_2在给予呼吸支持后12、24、48、72h均低于NCPAP组,差异具有统计学意义(均P0.05);两组患儿均痊愈出院,在气漏、持续肺动脉高压、支气管肺发育不良、视网膜病、肺出血、颅内出血等并发症发生率方面,其差异无统计学意义(P0.05);NHFV组在气管插管、上机时间及住院天数均少于NCPAP组,差异具有统计学意义(P0.05)。结论:无创高频通气治疗RDS疗效确切,且与CPAP通气模式相比,可减少RDS患儿CO_2潴留,增加氧合指数,减少上机时间及住院天数,值得临床推广应用。     

高频振荡通气在新生儿呼吸窘迫综合征中的临床应用

目的：探讨高频振荡通气（HFOV）作为新生儿呼吸窘迫综合征（RDS）初始治疗的疗效及安全性。方法回顾性分析2010年1月至2013年6月住院治疗、需机械通气的RDS患儿50例,2011年11月前以常频机械通气的25例患儿作为CMV组,2011年11月后以高频振荡通气的25例患者患者作为HFOV组。结果机械通气1h后,两组患儿吸入氧浓度（FiO2）、平均气道压（MAP）、动脉血二氧化碳分压（PCO2）动脉血氧分压（PO2）均较0h有不同程度改善,且在1h及6hHFOV组较CMV组改善更明显,差异有统计学意义（P〈0.05）;机械通气24h后HFOV组的PO2、MAP与CMV组比较,差异无统计学意义（P〉0.05）,PCO2差异有统计学意义（P〈0.05）。HFOV组患儿用氧时间与CMV组比较差异有统计学意义（P〉0.05）。两组气漏、颅内出血、心力衰竭、DIC发生率差异无统计学意义（P〉0.05）。两组患者休克发生率差异有统计学意义（P〈0.05）。HFOV发生休克症状的病人增多,但积极处理后可以缓解。结论 HFOV能更好更快的改善RDS患儿的氧合功能,缩短用氧时间,但24h后的疗效与CMV组比较无差别,未缩短使用呼吸机的时间。未明显增加并发症的发生,休克积极处理后可以纠正。HFOV可以作为治疗新生儿呼吸窘迫综合征的又一选择。     

高频振荡通气治疗新生儿呼吸窘迫综合征的随机对照研究

目的 研究高频振荡通气(HFOV)治疗新生儿呼吸窘迫综合征(NRDS)的疗效.方法 随机采取HFOV及常频机械通气(CMV)治疗NRDS患儿,比较其临床疗效、并发症.结果 HFOV组患儿在治疗后4、12、24 h氧合指数(OI)明显下降,并低于CMV组(P<0.01);两组患儿各时间点心率及平均动脉压比较差异无统计学意义(P>0.05). HFOV组患儿上机后1 d胸片较CMV组明显好转(P<0.05).HFOV组支气管肺泡灌洗液(BALF)中细胞总数及中性粒细胞于上机后1、2 d时较CMV组显著减少(P<0.01).两组患儿治愈率和死亡率比较差异无统计学意义;HFOV组上机时间和住院时间均低于CMV组(P<0.05),慢性肺疾病(CLD)、早产儿视网膜病(ROP)及气胸发生率均显著低于CMV组(P<0.05).结论 HFOV能更好地改善NRDS患儿的肺氧合功能,减轻炎性细胞浸润,减少并发症,降低住院时间和上机时间,具有很好的疗效.     

容量目标通气治疗早产儿呼吸窘迫综合征的疗效

目的观察容量目标通气(VTV)治疗早产儿呼吸窘迫综合征(RDS)的疗效。方法将2013年6月至2015年6月86例符合病例纳入标准的早产儿RDS患儿随机分为两组,各43例:VTV组采用同步间歇指令通气(SIMV)+压力调节(PSV)+目标容量控制通气(TTV)模式,压力控制通气组(PCV)采用SIMV+PSV模式,两组间性别比、出生胎龄与体重、使用固尔苏的剂量比较均无差别(P>0.05)。试验开始后6、24、48 h检查桡动脉血气分析,观察有创通气时间、氧疗时间、死亡率以及低碳酸血症、气胸、呼吸机相关性肺炎(VAP)、Ⅲ~Ⅳ级脑室周围-脑室内出血(PVH-IVH)、脑室周围白质软化(PVL)、支气管肺发育不良(BPD)、早产婴儿视网膜病变(ROP)的发生率。结果两组没有退出病例。VTV组有创通气时间[(72.63±12.14)h]较PCV组[(97.14±13.66)h]短(P<0.05);VTV组3次检查低碳酸血症的发生率分别为9.30%、11.63%、13.95%,PCV组分别为48.84%、58.14%、55.81%,分别比较两组3次血气分析中低碳酸血症的发生率,差别均有统计学意义(P<0.05);VTV组VAP、脑室周围白质软化的发生率(4.65%、2.33%)均低于PCV组(23.26%、18.60%)(P<0.05);VTV组吸氧时间为(168.65±39.12)h,PCV组为(167.87±38.95)h,差别无统计学意义(P>0.05);VTV组死亡率、气胸和Ⅲ~Ⅳ级PVH-IVH以及支气管肺发育不良、早产婴儿视网膜病变的发生率分别为:0、0、0、2.33%、2.33%,PCV组分别为:2.33%、0、2.33%、2.33%、4.65%,上述指标的比较差别均无统计学意义(P>0.05)。结论 VTV治疗早产儿RDS的疗效优于PCV,值得临床推广应用。     

高频振荡通气在新生儿呼吸窘迫综合征治疗中的应用

目的 探讨高频振荡通气(HFOV)治疗新生儿呼吸窘迫综合征(NRDS)的疗效及安全性.方法 对NRDS 64例,随机分为常频机械通气(CMV)30例和高频振荡通气(HFOV)34例,比较两组患儿治疗前后的血气分析、吸入氧浓度(FiO2)、氧合指数(OI)及并发症等.结果 HFOV组患儿吸入氧分数明显低于CMV组,PaCO2及氧合指数迅速下降,pH及PaO2明显上升,HFOV组发生肺气漏及慢性肺部疾病(CLD)等并发症低于CMV组(P<0.05).结论 HFOV用于治疗新生儿呼吸窘迫综合征,是一种疗效肯定、安全性好的新型机械通气方法.     

高频振荡通气治疗新生儿呼吸窘迫综合征的疗效观察及护理

[目的]总结高频振荡通气(HFOV)治疗新生儿呼吸窘迫综合征的疗效及护理要点。[方法]对新生儿重症监护室32例新生儿呼吸窘迫综合征的患儿采取HFOV,并与治疗时、治疗后8 h采集血气分析标本,比较两者之间的变化。[结果]32例患儿的血气分析在HFOV治疗后有显著改善,与治疗时比较差异有统计学意义(P<0.01)。[结论]HFOV是治疗新生儿呼吸窘迫综合征的有效方法之一,机械通气过程中的护理是保证治疗成功的关键。     

高频振荡通气治疗新生儿呼吸窘迫综合征的疗效观察及护理

[目的]总结高频振荡通气(HFOV)治疗新生儿呼吸窘迫综合征的疗效及护理要点.[方法]对新生儿重症监护室32例新生儿呼吸窘迫综合征的患儿采取HFOV,并与治疗时、治疗后8 h采集血气分析标本,比较两者之间的变化.[结果]32例患儿的血气分析在HFOV治疗后有显著改善,与治疗时比较差异有统计学意义(P<0.01).[结论]HFOV是治疗新生儿呼吸窘迫综合征的有效方法之一,机械通气过程中的护理是保证治疗成功的关键.     

鼻塞与鼻罩在无创通气治疗早产儿呼吸窘迫综合征中的效果

目的：了解鼻塞与鼻罩在无创通气治疗早产儿呼吸窘迫综合征（ RDS ）中的特点。方法选取2012年8月-2013年6月收治的符合入选标准的RDS早产儿,按照随机数字表法将患儿分为鼻塞组（48例）与鼻罩组（45例）。鼻塞组的无创通气连接界面选用短的双鼻塞,鼻罩组选用鼻罩。根据经皮血氧饱和度或血气分析调整FiO2等参数,记录各种参数及不良反应的发生率。结果鼻塞组无创正压通气后12～24 h血气分析的pH值为（7．32±0．06）,PaCO2值为（48．2±9．0） mmHg,正压通气24 h时FiO2值为（0．39±0．08）,腹胀3例,平均无创通气时间（54．1±16．8）h,无创通气失败12例;鼻罩组分别为（7．31±0．07）,（47．2±10．2）mmHg,（0．38±0．08）,5例,（54．8±13．6）h,9例,两组比较差异均无统计学意义（t/χ2值分别为0．169,0．484,0．464,0．217,-0．226,0．332;P＞0．05）。鼻塞组总脱落次数89次,总漏气次数352次,低于鼻罩组的48,489次,差异有统计学意义（χ2值分别为8．898,44．644;P＜0．05）。两组局部皮肤损伤发生率比较,差异无统计学意义（χ2＝0．009,P＞0．05）,但皮肤损伤部位明显不同：鼻塞组皮肤损伤部位绝大部分在鼻中隔的内侧和鼻小柱,鼻罩组皮肤损伤部位绝大部分在鼻中隔与人中连接处及眉间。结论鼻塞较鼻罩更容易脱落,鼻罩比鼻塞更容易漏气,但这两种连接界面对无创通气时间及无创通气失败率等并无明显的影响。鼻塞和鼻罩导致鼻部损伤的发生率及程度基本相似,但损伤部位明显不同。     

高频震荡通气治疗新生儿呼吸窘迫综合征的护理

新生儿呼吸窘迫综合征又称早产儿肺透明膜病,是新生儿重症监护病房常见的疾病之一,主要是由于缺乏肺泡表面活性物质致使胎儿出生后肺组织不能扩张,多见于早产儿,临床上以进行性呼吸困难为主要表现。高频振荡通气（HFOV）是用于解剖死腔的潮气量,以较高的频率通过胸壁的震动产生双向压力变化从而使肺组织进行有效气体交换的机械通气方法。     

Meta-regression analysis of high-frequency ventilation vs conventional ventilation in infant respiratory distress syndrome

Objective There is considerable heterogeneity among randomized trials comparing high-frequency ventilation (HFV) with conventional mechanical ventilation (CMV) in premature neonates with respiratory distress syndrome. We investigated what factors explained differences in outcome among these trials. Design Meta-regression analysis of 15 randomized trials. Measurements and results Variables were extracted to explain heterogeneity: year of publication; use of Sensormedics 3100A ventilator for HFV; time on CMV prior to start of study; gestational age; use of surfactant; high lung volume strategy in HFV; and lung protective ventilation strategy in CMV and baseline risk. Chronic lung disease (CLD) and death or CLD were outcome measures. Relative risk ratios were calculated to estimate effect sizes of explanatory variables on reported relative risks. Adjusted estimates of relative risk ratios of high lung volume strategy and lung protective ventilation strategy were 0.42 (95% CI 0.06–2.48) and 2.02 (95% CI 0.18–23.12) for CLD, respectively. The effect of gestational age was less pronounced (RRR = 1.17 (95% CI 0.16–8.32) for CLD, respectively). Use of Sensormedics and prior time on CMV had the smallest effects [RRR = 0.96 (95% CI 0.47–1.94) and RRR = 0.85 (95% CI 0.58–1.24) for CLD, respectively)]. The same results applied to CLD or death as outcome. Conclusions Variation in ventilation strategies that were used in trials comparing HFV with CMV in premature neonates offered the most likely explanation for the observed differences in the outcome of these trials compared with other explanatory factors. Electronic supplementary material The online version of this article () contains supplementary material, which is available to authorized users     

High-frequency ventilation and conventional mechanical ventilation in newborn babies with respiratory distress syndrome: A prospective,randomized trial

Objective Morbidity and mortality remain high amongst babies ventilated for a respiratory distress syndrome (RDS). Whether newly developed ventilators allowing high frequency ventilation such as high frequency flow interrupted ventilation (HFFIV) could decrease the morbidity and the mortality was investigated in a randomized study.Design Preterm babies weighing 1800g suffering from RDS and ventilated by conventional mechanical ventilation (CMV) were randomized to be further ventilated either by CMV (group CMV) or by HFFIV (group HFFIV) when peak inspiratory pressure (PIP) on CMV was 20cmH₂O.Setting The study was undertaken in the neonatal intensive care unit of the Erasmus Hospital.Patients 24 patients entered into the investigation and were randomized but 2 patients were removed from the study because the switch over to HFFIV failed. Eight of the 12 CMV patients and 5 of the 10 HFFIV patients completed the study.Measurements and results Clinical variables, blood gas analysis and ventilatory variables were looked at. There were no differences in mortality, in incidence of air leaks and pulmonary complications or in blood gas analysis. Bronchopulmonary dysplasia was not decreased by the use of HFFIV.Conclusion It is concluded that HFFIV is safe although it offers no concrete advantages over CMV when applied as we did in a low pressure approach.     

高频振荡通气在成人急性呼吸窘迫综合征中的应用进展

随着对急性呼吸窘迫综合征机械通气过程中呼吸机相关性肺损伤的理解加深,高频振荡通气被认为是一种理想的通气支持策略。高频振荡通气仍有多点不足,在成人急性呼吸窘迫综合征的临床应用中仍存在较大争议,尤其是最近两项大型多中心随机对照研究的结果令人失望。关于高频振荡通气机制、技术、通气策略,监测体系需要进一步探索。     

High-frequency oscillatory ventilation in adult acute respiratory distress syndrome

Objective This study examined whether ARDS patients in whom predefined ventilator settings fail to maintain oxygenation and CO₂ removal can be safely transitioned to high-frequency oscillatory ventilation (HFOV), and whether HFOV use is efficacious.Design and setting Prospective observational study in the 14-bed intensive care unit of a university hospital.Patients and participants 42 patients with ARDS (APACHE II score 28 (IQR 24–37) and ventilation time prior HFOV 3.0 days (0.7–9.1).Measurements and results Gas exchange parameters and ventilator data were recorded before and during HFOV treatment (–12 h, –6 h, baseline, 10 min, 1 h, 6 h, 12 h, 24 h). Primary endpoints included: (a) P_aO₂/FIO₂ ratio 24 h after start of HFOV treatment or the last point of measurement if HFOV ended within the first 24 h; (b) HFOV-related complications. Post hoc analysis assessed the relationship between outcome and the response to HFOV, and between outcome and time of mechanical ventilation prior to HFOV. At baseline the median P_aO₂/FIO₂ ratio was 95 (IQR 62–129); after 24 h of HFOV the P_aO₂/FIO₂ ratio had increased significantly to 165 (88–225); only one patient developed a unilateral pneumothorax. Of the 42 patients 18 (43%) had died by day 30. Subset analyses showed a significantly higher 30-day mortality rate in patients with at least 3 days of mechanical ventilation prior to HFOV (64%) and in patients without oxygenation improvement after 24 h on HFOV (71%).Conclusions HFOV is an effective and safe method to ventilate ARDS patients. Failure to improve oxygenation within 24 h of HFOV is associated with high mortality.An editorial regarding this article can be found in the same issue     

INSurE技术治疗早产儿呼吸窘迫综合征的临床观察

目的探讨INSur E技术治疗早产儿呼吸窘迫综合征的临床疗效。方法选取2010年至2011年于我院进行治疗的25例患呼吸窘迫综合征的早产儿为对照组,应用持续正压通气的呼吸支持方法治疗;2012年至2013年23例患呼吸窘迫综合征的早产儿为观察组,采用INSURE技术治疗。比较两组患儿治疗前后动脉血气分析(包括动脉血氧分压Pa O2、二氧化碳分压Pa CO2、氧合指数Pa O2/Fi O2、p H等)改善情况,以及呼吸支持使用时间、氧疗时间、住院时间、并发症等。结果两组治疗后24 h的p H、Pa O2、Pa O2/Fi O2均较治疗前有不同程度上升,Pa CO2均较治疗前有不同程度下降(P0.05);观察组无创通气时间[(68.8±16.1)h]、氧疗时间[(8.5±3.6)d]、住院时间[(19.8±6.2)d]均优于对照组,且差异有统计学意义(P0.05);观察组呼吸暂停、BPD发生率、有创通气与病死率均低于对照组(P0.05)。结论早产儿呼吸窘迫综合征应用INSURE技术进行呼吸支持治疗能够缩短无创通气时间、住院时间,并发症少,且操作方便,安全性高。     

无创正压通气治疗创伤性湿肺的临床研究

目的 观察无创正压通气（NIPPV）治疗创伤性湿肺的疗效。方法 选择30例行无创正压通气治疗的创伤性湿肺患者为治疗组，24例未用NIPPV治疗的创伤性湿肺患者为对照组，通过对2组患者进行心电监测、血氧饱和度、呼吸频率、血气分析等指标的监测，比较2组患者呼吸频率和动脉血气参数、肺部病变吸收时间、气管插管率、ICU住院时间及预后。结果 30例创伤性湿肺患者经NIPPV治疗后动脉血气指标与临床表现明显改善（P〈0．01）；与对照组相比，NIPPV治疗组患者临床症状改善时间、肺部病变吸收时间、ICU住院时间明显缩短（P〈0．01），肺实变率显著减低（P〈0．05），但2组患者气管插管率和病死率差异却无显著性。结论 NIPPV通过调节压力支持与呼吸末正压水平，早期应用可明显改善创伤性湿肺患者病情及缩短病程，但并不能改善其预后。     

俯卧位通气法在PICU呼吸窘迫综合征中的应用效果

目的 探讨俯卧位通气法对儿科重症监护室(pediatric intensive care unit,PICU)呼吸窘迫综合征(respiratory distress syndrom,RDS)患儿的影响.方法 选取2018年6月-2019年9月入住PICU呼吸窘迫综合征患儿作为研究对象,采用随机数字表法将其分为观察组3...     

呼吸窘迫综合征早产儿宫外发育迟缓的危险因素分析

目的探讨新生儿呼吸窘迫综合征(RDS)早产儿宫外发育迟缓(EUGR)相关危险因素,以探讨预防对策。方法收集2011年1月1日至2012年10月31日新生儿重症监护室的60例适于胎龄儿的RDS早产儿的临床资料,根据出院时体质量与矫正胎龄的关系,分为EUGR组与非EUGR组,应用SPSS 17.0软件进行数据分析,比较两组基本情况、围产期因素、营养摄入情况、治疗措施及并发症方面的差异;并对相关因素进行Logistic回归分析,筛选出RDS早产儿宫外发育迟缓的高危因素。结果适于胎龄的RDS早产儿宫外发育迟缓发生率为56.67%(34/60)。EUGR组与非EUGR组出生体质量、最小体质量、多胎妊娠、分娩方式差异有统计学意义(P<0.05),在胎龄、营养摄入情况、治疗措施及并发症方面差异无统计学意义(P>0.05)。Logistic回归分析:恢复出生体质量时间、多胎妊娠为危险因素,产前激素应用为保护性因素。结论适于胎龄的RDS早产儿EUGR与多胎妊娠、剖宫产、出生体质量低、最小体质量有关,恢复出生体质量时间及多胎妊娠为EUGR危险因素。     

Inability to predict outcome of acute respiratory distress syndrome in children when using high frequency oscillation

Objective To (a) describe the experience with high-frequency oscillation (HFO) in children with acute respiratory distress syndrome (ARDS) unresponsive to conventional ventilation; (b) compare observed survival to that predicted by pediatric mortality scores and (c) determine if oxygenation index changes during HFO can predict survival.Design Retrospective, observational study.Setting A university hospital pediatric intensive care unit.Patients Nineteen children with ARDS (PaO₂/FIO₂<200) unresponsive to conventional ventilation treated with HFO from January 1995 to September 1996.Interventions None.Measurements and results The following were recorded: demographic, arterial blood gas and ventilator variables at the time points 0, 6, 12 and 24 h after the start of HFO; PRISM in the first 24 h of admission and pediatric respiratory failure and multiple organ system failure scores on the day of starting HFO. The mortality rate was 26% (5/19). The survival was better than predicted by the Pediatric Respiratory Failure score (p<0.01). None of the scores differentiated survivors from non-survivors (p>0.25). There was no significant change in oxygenation index over the first 24 h (p>0.18). Of patients with an initial oxygenation index higher than 20 who did not have at least a 20% reduction in oxygenation index by the time 6 h, 6/9 (67%) survived (sensitivity 75%, specificity 57%).Conclusions Survival in pediatric ARDS patients treated with HFO could not be predicted using several outcome scores or the oxygenation index (in the first 24 h). Survival was significantly better than predicted by the Pediatric Respiratory Failure score. A prospective randomized controlled trial of HFO in ARDS is warranted.     

早产儿湿肺伴急性呼吸窘迫综合征的临床分析

目的 探讨早产儿湿肺伴急性呼吸窘迫综合征的临床特点和机械通气治疗的效果。方法 分析我科1998年1月至2002年8月收治的30例早产儿湿肺伴急性呼吸窘迫综合征的临床表现、动脉血气变化及机械通气疗效结果早产儿湿肺伴急性呼吸窘迫综合征者占同期新生儿湿肺总数的20％(30／150)。30例均为削宫产临床表现以气促、呼吸闲难、青紫为主。24h后明显加重。胸片显示急性呼吸窘迫综合征。30例均需机械通气治疗,5、6d临床症状明显好转,全部治愈。结论 早产儿湿肺可继发急性呼吸窘迫综合征,动态观察胸片变化和及时行机械通气治疗有助于治疗。