无创高频机械通气对呼吸衰竭新生儿肺氧合能力、CO2潴留和酸中毒的影响

目的 探究无创高频机械通气对新生儿呼吸衰竭（NRF）患儿肺氧合能力、二氧化碳（CO2）潴留和酸中毒的影响。方法 回顾性分析我院经无创高频震荡通气（HFOV）治疗（nHFOV组）及经常频机械通气（CMV）治疗（CMV组）各 62例 NRF患儿的临床资料。记录 2组临床疗效、治疗期间并发症发生情况［气压伤、颅内出血、肺气漏、气胸、呼吸机相关肺炎（VAP）］及存活患儿治疗时间（机械通气时间、氧疗时间、总住院时间），并比较 2组治疗前（T0）、治疗后 12 h（T1）、治疗后 24 h（T2）血气分析指标［动脉血氧分压 p（O2）、动脉血二氧化碳分压 p（CO2）、酸碱度（pH）］、呼吸功能指标［氧合指数（OI）、吸入氧分数（FiO2）、平均气道压（MAP）］差异。结果 nHFOV组临床疗效明显优于 CMV组（P＜0.05）。nHFOV组存活患儿机械通气时间、氧疗时间、总住院时间均明显低于 CMV组（P＜0.05）。2组各时间点p（O2）、pH比较均为 T0＜T1＜T2（P＜0.05），p（CO2）水平及呼吸功能指标（OI、FiO2、MAP）比较则为 T0＞T1＞T2（P＜0.05）；且 T1 及 T2 时，nHFOV 组 p（O2）、pH 水平均高于 CMV 组（P＜0.05），p（CO2）水平及 OI、FiO2、MAP 水平则低于CMV组（P＜0.05）。nHFOV组气压伤和 VAP发生率明显低于 CMV组（P＜0.05）；2组颅内出血、肺气漏、气胸发生率差异无统计学意义。结论 nHFOV治疗 NRF效果较好，可提高患儿肺氧合功能，并纠正 CO2潴留、酸中毒状态，且避免发生气压伤，有利于患儿病情恢复。

Effects of nasal high-frequency oscillation ventilation on pulmonary oxygenation capacity,CO2 retention and acidosis in neonates with respiratory failure

Objective To explore the effects of nasal high-frequency oscillation ventilation (HFOV) on pulmonary oxygenation capacity, carbon dioxide (CO2) retention and acidosis in children with neonatal respiratory failure (NRF).Methods The clinical data of 62 child patients with NRF who underwent nasal HFOV (nHFOV group) and conventional mechanical ventilation (CMV group) were retrospectively analyzed. The clinical efficacy, occurrence of complications during treatment barotrauma, intracranial hemorrhage, lung air leaks,pneumothorax, ventilator associated pneumonia (VAP)] and treatment time of surviving patients (mechanical ventilation time, oxygen therapy time, total hospital stay) were recorded in the two groups. The blood gas analysis indicators arterial partial pressure of blood oxygen p(O2), arterial partial pressure of blood carbon dioxide p(CO2), pH value] and respiratory function indicators oxygenation index (OI), fraction of inspiration oxygen (FiO2), mean airway pressure (MAP)] were compared before treatment (T0), at 12 h after treatment (T1) and at 24 h after treatment (T2) between the two groups. Results The clinical efficacy was significantly better in nHFOV group than that in CMV group (P＜0.05). There were no significant differences in the occurrence of intracranial hemorrhage, pulmonary air leaks and pneumothorax between the two groups (P＞0.05). The incidence rates of barotrauma and VAP and the mechanical ventilation time, oxygen therapy time and total hospital stay of surviving patients were significantly lower in nHFOV group than those in CMV group (P＜0.05). The blood gas analysis indicators［p(O2) and pH］in the two groups at each time point showed those at T0＜at T1＜at T2 (P＜0.05), and the comparison of p(CO2) level and respiratory function indicators (OI, FiO2 and MAP) showed those at T0＞at T1＞ at T2 (P＜0.05). And at T1 and T2, the p(O2) and pH levels were significantly higher in nHFOV group than those in CMV group (P＜0.05), and the p(CO2) level and OI, FiO2 and MAP levels were significantly lower than those in CMV group (P＜0.05). Conclusion nHFOV has good effects in the treatment of NRF,and it can improve the pulmonary oxygenation function, correct the states of CO2 retention and acidosis, and avoid the occurrence of barotrauma. And it is beneficial to the disease recovery.