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目的:观察高频振荡通气(HFOV)治疗新生儿急性呼吸窘迫综合征(NRDS)的效果。方法:随机选取应用高频振荡通气治疗NRDS的新生儿23例及同期常规正压通气治疗的NRDS新生儿22例,比较其临床疗效、胸片、血气分析、住院时间、并发症等。结果:HFOV组存活20例,脑室内出血(IVH)3例,肺出血1例,无气漏发生;自动出院2例,死亡1例;存活儿使用呼吸机平均时间90.5 h。CMV组存活18例,脑室内出血3例,肺出血3例,气漏2例,自动出院2例,死亡2例;存活儿使用呼吸机平均时间为124.5 h。HFOV组患儿在治疗后12、24 h氧合指数(OI)明显上升,与CMV组比较差异有统计学意义(P<0.01);HFOV组上机后24h胸片较CMV组明显好转(P<0.05)。两组的治愈率和死亡率比较,差异无统计学意义;HFOV组气胸发生率、上机时间和住院时间均低于CMV组(P<0.05)。结论:高频振荡通气作为肺保护措施能更好地改善NRDS患儿的肺氧合功能,迅速、持续地增加气体的交换量,并可有效减少气压伤及并发症,缩短上机时间,减少患儿住院时间及费用,较常频呼吸机更为安全。
Objective: To observe the effect of high frequency oscillatory ventilation (HFOV) on neonatal acute respiratory distress syndrome (NRDS). Methods: Twenty-three neonates with NRDS were treated with high-frequency oscillatory ventilation and 22 neonates with NRDS under conventional positive pressure ventilation. The clinical effects, chest radiograph, blood gas analysis, hospitalization time and complications were compared. Results: There were 20 cases in HFOV group, 3 cases of intraventricular hemorrhage (IVH) and 1 case of pulmonary hemorrhage without air leakage. Two cases were discharged automatically and 1 case died. The mean duration of ventilator use in survivors was 90.5 hours. There were 18 cases of CMV group, 3 cases of intracerebral hemorrhage, 3 cases of pulmonary hemorrhage, 2 cases of air leak, 2 cases of spontaneous discharge and 2 cases of death. The mean duration of ventilator use in survivors was 124.5 hours. The oxygenation index (OI) in HFOV group was significantly increased at 12 and 24 h after treatment (P <0.01), while the chest radiograph in HFOV group was significantly improved after 24 h (P <0.05). There was no significant difference in cure rate and mortality between the two groups. The incidence of pneumothorax, up-time and hospital stay in HFOV group were lower than those in CMV group (P <0.05). CONCLUSIONS: High-frequency oscillatory ventilation, as a lung protection measure, can better improve the pulmonary oxygenation function in children with NRDS, rapidly and continuously increase the amount of gas exchange, and can effectively reduce the complications of barotrauma, shorten the on-board time and reduce Children hospitalization time and costs, more frequent than the ventilator more secure.