高频振荡通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征

目的:研究高频振荡通气(high frequency oscillatory ventilation,HFOV)与常频机械通气(conventional mechanical ventilation,CMV)分别联合肺表面活性物质(pulmonary surfactant,PS)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的临床疗效。方法:选择2014年1月至2015年12月于襄阳市中心医院新生儿重症监护病房(NICU)住院诊断为NRDS的患儿60例,根据胎龄、出生体重随机分为HFOV组(n=28)和CMV组(n=32)。分别给予HFOV+PS和CMV+PS。比较两组患儿治疗前及治疗后2 h、12 h、24 h的氧分压(Pa O2)、二氧化碳分压(Pa CO2)和氧合指数(OI),同时比较上机时间以及发生肺气漏、肺出血、支气管肺发育不良(BPD)的发生率。结果:治疗后2 h、12 h及24 h,两组患儿的OI、Pa CO2均呈现下降,Pa O2上升,但HFOV组的治疗后效应明显于CMV组,差异有统计学意义(P<0.05)。同时,HFOV组上机时间较CMV组明显缩短(P<0.05),发生肺气漏比率低于CMV组(P<0.05),但肺出血、BPD发生率两组间差异无统计学意义(P>0.05)。结论:在NRDS的治疗过程中,HFOV联合PS较传统的CMV联合PS具有更多优势,如改善氧合,减少肺损伤。

High frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal respiratory distress syndrome

Objective:To study the effectiveness of pulmonary surfactant (PS) combined with high frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) in neonatal respiratory distress syndrome (NRDS).Methods:A total of 60 neonates diagnosed with NRDS between January 2014 and December 2015 in the NICU of Xiangyang Central Hospital.The neonates were randomly divided into two groups:HFOV group (n=28) and CMV group (n=32),based on their gestational age and birth weight.HFOV group was given high frequency oscillatory ventilation and CMV group was given normal frequency oscillatory ventilation,all combined with pulmonary surfactant (PS).Compare oxygen partial pressure (PaO2),partial pressure of carbon dioxide (PaCO2) and oxygenation index (OI) before and after 2 h,12 h,24 h of treatment,at the same time the mechanical ventilation time and occurrence rates of complicantions such as lung leakage,pneumorrhagia and bronchopulmonary dysplasia were compared.Results:After treatment 2 h,12 h and 24 h,in two groups OI and PaCO2 decreased,at the same time PaO2 increased.But the effects of HFOV group were more obvious,with statistical significance(P<0.05).While,mechanical ventilation time was obviously shorter than CMV group (P<0.05),and occurrence of lung leakage ratio is lower than CMV group (P<0.05),but BPD and pneumorrhagia in the two groups had no statistically significance (P>0.05).Conclusion:In treatment of NRDS,HFOV+PS is more effective than CMV+PS to improve oxygenation,reduce lung injury.