高频振荡通气治疗新生儿持续肺动脉高压疗效评价

摘要

Objective To evaluate the effectiveness and safety of high frequency oscillatory ventilation in the treatment of newborns with persistent pulmonary hypertension. Methods This was a retrospective case control study based on data collected by the medical records from June 2007 to February 2012. Fifty-nine newborns with persistent pulmonary hypertension were involved in this study,and divided into high frequency oscillatory ventilation group(HFOV group) and conventional mechanical ventilation group(CMV group) by the ventilation mode. The infants' clinical data and outcomes were collected and analyzed. The statistical study was performed using SPSS11. 5 software. Fisher' s exact probability test and Pearson' s chi-squared test were used to compare quantitative variables between independent groups. P-values were considered significant when they were less than 0. 05 (two-sided). Results Age after birth was significantly different between two groups(P <0.05). Meconium stained amniotic fluid and meconium aspiration pneumonia( MAS) were significantly different between two groups (P <0.05). Pulmonary hypertension of newborn in HFOV group was more severe than that in CMV group(.P < 0. 05 ) . Blood gas analysis showed that partial pressure of carbon dioxide ( PCO2 ) and inspired oxygen concentration ( FiO2 ) were decreased after high frequency oscillatory ventilation(P < 0. 01). Partial pressure of oxygen( PO2 ) and transcutaneous oxygen saturation( SaO2) were increased at the same time( P <0.01). Inhaled oxygen concentration(FiO2) in HFOV group was lower than that in CMV group after 6 - 8 h ventilation (P < 0.05). MgSO4 application and incidence of intracranial hemorrhage between two group were not significantly different(P >0. 05). Incidences of pneumothorax and thoracic drainage in HFOV group were lower than that in CMV group( P < 0. 05 ). Conclusion High-frequency oscillatory ventilation in the treatment of neonates with persistent pulmonary hypertension is effective. HFOV for infants suffering from pneumothorax may reduce the thoracic drainage. High-frequency oscillatory ventilation may not increase the risk of intracranial hemorrhage.%目的 评价高频振荡通气对新生儿持续肺动脉高压治疗的有效性及安全性. 方法 对我院2007-06～2012-02NICU病房收治的59例新生儿持续肺动脉高压进行回顾性分析,按机械通气方式分为高频振荡通气组(HFOV组)及常频机械通气组(CMV组),对两组患儿一般情况、临床治疗及疗效评价相关数据进行统计学分析. 结果 两组患儿一般情况及宫内情况比较显示CMV组年龄大于HFOV组(P＜0.05)；羊水粪染HFOV组多于CMV组；两组原发病比较胎粪吸人性肺炎(MAS)差异显著(P＜0.05)；HFOV组肺动脉高压程度重于CMV组(P＜0.05)；高频振荡机械通气前、后血气变化显示机械通气后二氧化碳分压(PCO2)、吸入氧浓度(FiO2)较机械通气前下降；氧分压(PO2)及经皮氧饱和度(SaO2)较机械通气前升高(均P＜0.01)；机械通气后HFOV组吸入氧浓度较CMV组更低(P ＜0.05)；MgSO4应用及颅内出血发生率两组间比较无统计学差异(均P＞0.05)；HFOV组合并气胸且行胸腔闭式引流少于CMV组(P＜0.05). 结论 高频振荡通气治疗新生儿持续肺动脉高压疗效肯定,且对合并气胸的患儿可以减少闭式引流操作,同时没有增加颅内出血危险.