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

郭梅; 王奇伟; 刘鼎立; 王磊

doi:10.16766/j.cnki.issn.1674-4152.002100

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

doi: 10.16766/j.cnki.issn.1674-4152.002100

郭梅¹,
王奇伟¹,
刘鼎立¹,
王磊^2, ,

1.
阜阳市妇女儿童医院儿科, 安徽阜阳 236000
2.
蚌埠医学院第一附属医院儿科，安徽蚌埠 233004

基金项目:

安徽省高校自然科学研究重点项目 KJ2019A0342

详细信息

通讯作者:
王磊，E-mail：125633418@qq.com

中图分类号: R563.8 R722.1
计量
- 文章访问数: 149
- HTML全文浏览量: 61
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-23
- 网络出版日期: 2022-02-15

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

1.
Department of Pediatrics, Women and Children Hospital of Fuyang, Fuyang, Anhui 236000, China

摘要

摘要: 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。
- 新生儿呼吸窘迫综合征 /
- 无创正压通气 /
- 无创高频震荡通气
Abstract: 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.
- Neonatal respiratory distress syndrome /
- Non-invasive positive pressure ventilation /
- Non-invasive high-frequency vibrating ventilation

HTML全文

图 1 肺野透明度

下载: 全尺寸图片幻灯片

图 2 心脏胸片及心影

下载: 全尺寸图片幻灯片

表 1 2组呼吸窘迫综合征患儿PO₂、PaCO₂、A/APO₂、SaO₂比较(x±s)

组别	例数	PO₂(mm Hg)					F值	P值
组别	例数	治疗前	治疗后12 h	治疗后24 h	治疗后48 h	治疗后72 h	F值	P值
NHFV组	36	44.35±1.55	55.47±0.28^a	62.46±0.29^a	70.41±0.25^a	85.50±0.22^a	18 144.587	< 0.001
NCPAP组	38	44.58±0.34	51.51±0.25^a	58.21±0.08^a	63.47±0.26^a	76.50±0.21^a	112 415.822	< 0.001
t值		0.899	64.425	87.123	117.229	180.429
P值		0.371	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	PaCO₂(mm Hg)					F值	P值
组别	例数	治疗前	治疗后12 h	治疗后24 h	治疗后48 h	治疗后72 h	F值	P值
NHFV组	36	56.59±0.20	48.44±0.33^a	44.41±0.24^a	40.49±0.29^a	29.53±0.24^a	33 802.566	< 0.001
NCPAP组	38	57.38±0.30	52.49±0.30^a	48.51±0.26^a	44.47±0.26^a	35.54±0.25^a	90 821.092	< 0.001
F值		13.104	55.445	70.456	62.334	106.527
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	A/APO₂					F值	P值
组别	例数	治疗前	治疗后12 h	治疗后24 h	治疗后48 h	治疗后72 h	F值	P值
NHFV组	36	0.22±0.03	0.38±0.02^a	0.47±0.01^a	0.62±0.01^a	0.77±0.01^a	5 009.302	< 0.001
NCPAP组	38	0.22±0.02	0.31±0.01^a	0.41±0.01^a	0.52±0.01^a	0.69±0.02^a	6 962.178	< 0.001
F值		0.714	20.341	23.765	40.258	20.830
P值		0.478	< 0.001	< 0.001	< 0.001	< 0.001

组别	例数	SaO₂(%)					F值	P值
组别	例数	治疗前	治疗后12 h	治疗后24 h	治疗后48 h	治疗后72 h	F值	P值
NHFV组	36	48.36±0.19	60.68±0.14^a	75.34±0.15^a	86.36±0.25^a	92.29±0.42^a	204 174.266	< 0.001
NCPAP组	38	48.33±0.20	55.51±0.30^a	65.36±0.20^a	72.39±0.22^a	85.70±0.68^a	58 700.643	< 0.001
F值		0.657	93.967	189.903	253.687	49.813
P值		0.514	< 0.001	< 0.001	< 0.001	< 0.001
注：与治疗前比较，^aP < 0.05。

下载: 导出CSV

表 2 2组呼吸窘迫综合征患儿并发症发生例数比较(例)

组别	例数	漏气	持续性肺动脉高压	支气管肺发育不良	视网膜病变	肺出血	颅内出血	合计
NHFV	36	1	4	1	2	0	2	10
NCPAP	38	0	5	2	3	1	3	14
注：2组患儿并发症发生例数比较，χ²=0.693，P=0.405。

下载: 导出CSV

表 3 2组呼吸窘迫综合征患儿呼吸机使用时间及住院时间比较(x±s，d)

组别	例数	呼吸机使用时间	住院时间
NHFV	36	3.81±0.49	11.23±0.80
NCPAP	38	5.08±0.50	15.50±1.06
t值		11.040	19.352
P值		< 0.001	< 0.001

下载: 导出CSV

参考文献(20)

[1]	SWEET D, BEVILACQUA G, CARNIELLI V, 等. 欧洲新生儿呼吸窘迫综合征防治共识[J]. 中华儿科杂志, 2008, 46(1): 30-34. doi: 10.3321/j.issn:0578-1310.2008.01.008
[2]	乔俊英, 李远哲, 王贺义, 等. 高频振荡通气与常频通气治疗小儿急性呼吸窘迫综合征疗效的Meta分析[J]. 中国当代儿科杂志, 2017, 19(4): 430-435. https://www.cnki.com.cn/Article/CJFDTOTAL-DDKZ201704017.htm
[3]	GONZÁLEZ-PACHECO N, SÁNCHEZ-LUNA M, RAMOS-NAVARROS-NAVARRO C, et al. Using very high frequencies with very low lung volumes during high-frequency oscillatory ventilation to protect the immature lung. A pilot study[J]. J Perinatol, 2016, 36(1): 306-310. http://www.researchgate.net/profile/Manuel_Sanchez_Luna/publication/289534608_Using_very_high_frequencies_with_very_low_lung_volumes_during_high-frequency_oscillatory_ventilation_to_protect_the_immature_lung_A_pilot_study/links/57738fec08ae1b18a7ddfed5.pdf
[4]	邵方平, 戚永娥, 柴容, 等. 预警分级管理对危重早产儿院内转运时间及不良事件发生的影响[J]. 中华全科医学, 2020, 18(6): 972-975. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY202006024.htm
[5]	ZHU X W, SHI Y, SHI L P, et al. Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: Study protocol for a multi-center prospective randomized controlled trial[J]. Trials, 2018, 19(1): 319. doi: 10.1186/s13063-018-2673-9
[6]	JOACHIM M, PETER H, PATRICJK H, et al. One-year resource utilisation, costs and quality of life in patients with acute respiratory distress syndrome (ARDS): Secondary analysis of a randomised controlled trial[J]. J Intensive Care, 2016, 4(1): 56. doi: 10.1186/s40560-016-0178-8
[7]	杨玉兰, 吴本清, 苏锦珍, 等. 经鼻高频通气治疗新生儿呼吸窘迫综合征效果的系统评价[J]. 中国当代儿科杂志, 2018, 20(11): 897-903. doi: 10.7499/j.issn.1008-8830.2018.11.004
[8]	陈文霞, 张雪, 付扬喜, 等. 持续无创呼吸机辅助通气结合布地奈德和猪肺磷脂注射液治疗支气管肺发育不良低出生体重儿临床观察[J]. 海南医学, 2017, 28(23): 3851-3854. doi: 10.3969/j.issn.1003-6350.2017.23.021
[9]	陈炎, 刘成, 关玉研. 肺表面活性物质联合无创双水平正压通气治疗新生儿呼吸窘迫综合征的临床观察[J]. 现代诊断与治疗, 2018, 29(14): 2253-2255. doi: 10.3969/j.issn.1001-8174.2018.14.036
[10]	范雪, 陈娟. 早产儿初始持续气道正压通气失败的危险因素分析[J]. 华西医学, 2017, 32(4): 586-588. https://www.cnki.com.cn/Article/CJFDTOTAL-HXYX201704028.htm
[11]	聂明月, 王欣, 段华, 等. 双胎妊娠早产危险因素的临床分析[J]. 实用妇产科杂志, 2017, 33(11): 856-859. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ201711020.htm
[12]	MD A O S, MD A O E, MD I O, et al. Impact of targeted-volume ventilation on pulmonary dynamics in preterm infants with respiratory distress syndrome[J]. Pediatr Pulmonol, 2017, 52(2): 213-216. doi: 10.1002/ppul.23510
[13]	张翠平, 崔银珠. 新生儿肺出血采用高频振荡叠加常频通气治疗的临床有效性与安全性观察[J]. 齐齐哈尔医学院学报, 2018, 39(14): 1665-1666. doi: 10.3969/j.issn.1002-1256.2018.14.022
[14]	郑玉辉, 唐艺, 黄景泉. 高频振荡通气叠加常频机械通气联合西地那非治疗新生儿持续性肺动脉高压的临床研究[J]. 中国现代药物应用, 2019, 13(24): 59-60. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY201924029.htm
[15]	陈艳江. 肺泡表面活性物联合高频振荡通气对新生儿呼吸窘迫综合征的疗效研究[J]. 中国实用医刊, 2017, 44(16): 120-122. doi: 10.3760/cma.j.issn.1674-4756.2017.16.039
[16]	李震雷, 李风雷. 胎心监护和血气分析对脐带异常的围生儿监测的临床意义[J]. 检验医学与临床, 2016, 13(5): 679-681. doi: 10.3969/j.issn.1672-9455.2016.05.043
[17]	霍汝亚寒, 陈晶, 刘恒. 高频震荡通气联合肺泡表面活性物质治疗新生儿呼吸窘迫综合征[J]. 临床肺科杂志, 2016, 21(8): 1535-1537. doi: 10.3969/j.issn.1009-6663.2016.08.052
[18]	彭丽娟, 富建华. 早产儿支气管肺发育不良的呼吸系统及神经系统远期预后[J]. 国际儿科学杂志, 2016, 43(7): 548-551, 556. doi: 10.3760/cma.j.issn.1673-4408.2016.07.009
[19]	PRABHAKARAN K, HAGLER D, VITALE D, et al. High-frequency oscillatory ventilation (HFOV) as primary ventilator strategy in the management of severe acute respiratory distress syndrome (ARDS) with pneumothorax in the setting of trauma[J]. Am Surg, 2017, 83(3): 99-101. doi: 10.1177/000313481708300313
[20]	常明, 卢红艳, 相虹, 等. 不同机械通气方式联合肺表面活性物质对新生儿急性肺损伤/急性呼吸窘迫综合征疗效比较[J]. 中国当代儿科杂志, 2016, 18(11): 1069-1074. doi: 10.7499/j.issn.1008-8830.2016.11.003