无创高频震荡通气在新生儿呼吸窘迫综合征治疗中的应用

  目的  探讨采用无创高频震荡通气与持续气道正压通气治疗新生儿呼吸窘迫综合征的临床效果、能否减少并发症发生率以及是否可以缩短住院时间和减少住院次数。   方法  选择2018年1月—2019年12月期间在阜阳市妇女儿童医院新生儿重症监护室(NICU)的74例呼吸窘迫综合征新生儿，按照随机数表法分为无创高频(non-invasive high frequency ventilation, NHFV)组36例和无创正压通气(non-invasive positive pressure ventilation, NCPAP)组38例，分别比较治疗前和治疗后12、24、48、72 h的动脉血中含氧量、并发症发生率、使用呼吸机时间及总住院时间。   结果  给予相应的呼吸支持后12、24、48、72 h，NHFV组血氧分压(PO₂)、肺泡动脉氧分压(A/APO₂)、血氧饱和度(SaO₂)均高于NCPAP组，PaCO₂(48.44±0.33)mm Hg(1 mm Hg=0.133 kPa)、(44.41±0.24)mm Hg、(40.49±0.29)mm Hg、(35.54±0.25)mm Hg)]均低于NCPAP组(均P < 0.05)。2组患儿均治愈出院，相关并发症如漏气、持续性肺部高压、支气管肺发育不良、视网膜病变、肺出血、颅内出血等并发症发生率差异无统计学意义(P>0.05)。NHFV组的呼吸机使用时间和住院时间均少于NCPAP组，差异有统计学意义(均P < 0.05)。   结论  无创高频通气是治疗新生儿呼吸窘迫综合征的有效方法，与传统的持续气道正压通气模式相比，可以显著减少呼吸窘迫综合征患儿的CO₂滞留，提高氧合指数，缩短住院时间，值得临床进一步研究。 

Application of non-invasive high-frequency oscillatory ventilation in infant respiratory distress syndrome

  Objective  To investigate the clinical effect of non-invasive high-frequency concussion ventilation and continuous positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome, whether it can reduce the incidence of complications and whether it can shorten the length of stay and reduce the number of hospitalisations.   Methods  A total of 74 cases of neonatal respiratory distress syndrome admitted in the NICU in our department from January 2018 to December 2019 were included. According to random number table method, the patients were divided into the non-invasive high-frequency group (NHFV group, 36 cases) and non-invasive positive pressure ventilation group (NCPAP group, 38 cases). The arterial blood oxygen levels, complications, duration of ventilator use and total length of hospital stay were compared before and after treatment at 12, 24, 48 and 72 h.   Results  PO₂, A/APO₂ and SaO₂ in the NHFV group were higher than those in the NCPAP group at 12, 24, 48 and 72 h after respiratory support, and PaCO₂ levels in the NHFV group at 12, 24, 48 and 72 h were lower than those in the NCPAP group, respectively (all P < 0.05). Both groups were treated and discharged, and no statistical significance was observed in the incidence of complications such as air leakage, persistent pulmonary hypertension, bronchopulmonary dysplasia, retinopathy, pulmonary haemorrhage, intracranial haemorrhage and other complications (all P>0.05). The duration of ventilator use and hospital stay in the NHFV group were shorter than those in the NCPAP group, and the difference was statistically significant (all P < 0.05).   Conclusion  Non-invasive high-frequency ventilation is an effective method for the treatment of neonatal respiratory distress syndrome. Compared with the traditional CPAP ventilation mode, it can significantly reduce CO₂ retention, improve oxygenation index and shorten the length of hospital stay in children with respiratory distress syndrome, which is worthy of further clinical study.