高频振荡通气治疗新生儿肺出血的临床研究

摘要

目的 探讨高频振荡通气(HFOV)治疗新生儿肺出血的有效性及安全性.方法 回顾性分析高频和常频通气(CMV)治疗肺出血患儿62例的临床效果,比较两组患儿的肺氧合功能、肺出血时间、住院时间、上机时间、氧疗时间、合并症及转归.结果 HFOV组治疗后1、6、12、24、48、72 h 氧合指数(OI)明显低于CMV组,动脉/肺泡氧分压(a/APO2)明显高于CMV组,差异有统计学意义(P ＜ 0.05).HFOV组呼吸机相关性肺炎(VAP)发生率明显低于CMV组(P ＜ 0.05),治愈率增高(P ＜ 0.05).HFOV组气胸、颅内出血、消化道出血、血糖异常、败血症、肾功能损害的发生率与CMV组比较差异无统计学意义(P ＞ 0.05).存活患儿中,HFOV组在肺出血时间、住院时间、上机时间、氧疗时间较CMV组明显缩短(P ＜ 0.05).结论 HFOV能更好地改善肺出血患儿氧合功能,降低VAP的发生率,缩短病程,提高治愈率,与CMV组比较并不增加不良反应的发生率.%Objectives To investigate the efficacy and safety of high-frequency oscillatory ventilation (HFOV)for the treatment of pulmonary hemorrhage in newborn infants. Methods The clinical effect for the treatment of pulmonary hemorrhage was retrospectively evaluated in 30 newborn infants with HFOV and 32 newborn infants with conventional mechanical ventilation (CMV) by comparing the oxygenate function, the duration of pulmonary hemorrhage, the length of hospital stay, the duration of mechanical ventilation, the duration of oxygen therapy,complications and prognosis. Results The oxygen index (OI) was lower obviously and the arterial/alveolar oxygen tension ratio (a/APO2) was higher markedly at 1, 6, 12, 24, 48 and 72 h after treatment in the HFOV group compared to those in the CMV group, respectively (P ＜0.05 for all). There were significantly the lower incidence of ventilator-associated pneumonia (VAP) and the higher recovery rate in the HFOV group compared to those in the CMV group (P＜0.05 for all). No statistically differences in the incidences of pneumothorax, intracranial hemorrhage,digestive tract hemorrhage, pathoglycemia, septicemia and renal impairment were found between two groups (P＞0.05 for all). In survived infants the duration of pulmonary hemorrhage, the length of hospital stay, the duration of mechanical ventilation, and the duration of oxygen therapy were no differences between two groups. Conclusions HFOV may be a relatively safe and effective means for the treatment of pulmonary hemorrhage in newborn infants.