目的：探讨联合应用肺表面活性物质（ PS）、高频振荡通气（ HFOV）、吸入一氧化氮（ iNO）治疗新生儿重度呼吸衰竭的效果。方法选择2011年2月-2013年8月安徽省儿童医院新生儿重症监护室（ NICU）收治的重度呼吸衰竭新生儿34例，在基础治疗的基础上联合应用PS、HFOV、iNO进行治疗。观察所有患儿治疗前及治疗后1、6、24 h动脉血气指标和呼吸功能指标及转归情况等。结果本组患儿治疗后1、6、24 h的pH值和动脉血氧分压（PaO2）大于治疗前，二氧化碳分压（PaCO2）小于治疗前（P﹤0.05）；治疗后1、6、24 h的吸入氧浓度（FiO2）和氧合指数（OI）小于治疗前（P﹤0.05）；治疗后6、24 h的平均气道压（MAP）小于治疗前（P﹤0.05）；治疗后1、6、24 h的动脉肺泡氧分压比值（a/A）大于治疗前（P﹤0.05）。本组患儿平均iNO有效浓度为（10.4±2.3）ppm，平均iNO时间为（42.5±8.9） h；治愈25例，9例因病情危重家属放弃治疗而死亡。结论联合应用 PS、HFOV、iNO治疗新生儿重度呼吸衰竭可以改善其动脉血气指标和呼吸功能指标，改善其氧合，有一定的推广应用价值。%Objective To explore the efficacy and safety of pulmonary surfactant( PS) and inhalation of nitric oxide (iNO)combined high frequency oscillatory ventilation(HFOV)in treatment of infants with severe respiratory failure(SRF). Methods Thirty-four SRF infants admitted to NICU of Anhui Children' Hospital from February 2011 to August 2013 were given combined treatment of PS,iNO,HFOV based on basic treatment. The indicators of arterial blood gas( ABG) and respiratory function,outcomes and so on were observed before treatment and at hours 1,6,24 after. Results The pH,PaO2 were higher, PaCO2 lower at hours 1,6,24 after treatment than before treatment(P﹤0. 05). The FiO2,oxygenation index(OI)at hours 1,6,24 after treatment,and mean airway pressure( MAP) at hours 6,24 after treatment were lower,the alveolar oxygen partial pressure ratio(a/A)at hours 1,6,24 after treatment higher than before treatment. The mean iNO effective concentra-tion was(10. 4 ± 2. 3) ppm,mean iNO time was(42. 5 ± 8. 9) h. Twenty-five infants were cured,9 died because of family members' treatment abandoning due to critical condition. Conclusion Combination of PS,HFOV,iNO can improve the indica-tors of ABG,respiratory function and oxygenation in SRF infants.
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