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目的探讨高频振荡通气(HFOV)联用一氧化氮(NO)吸入治疗新生儿气胸的疗效。方法选择2003年7月-2008年10月本院新生儿科收治的37例气胸新生儿,均行床边X线胸片,提示肺组织压缩均超过60%,在出现气胸后均接受胸腔闭式引流及机械通气。37例气胸新生儿依治疗方法不同分为2组:HFOV组和HFOV+NO组。HFOV组17例,在出现气胸后机械通气模式选择HFOV治疗;HFOV+NO组20例,在给予HFOV治疗的同时吸入NO,吸入NO水平为(5~15)×10-6。2组在治疗2 h、12 h、24 h及以后每24 h行血气分析,并详细记录呼吸机参数,计算氧合指数(OI),持续监测NO/NO2水平。结果 2组治疗后2 h氧合情况持续改善,OI值、吸入氧浓度(FiO2)、平均呼吸道压均逐渐降低,动脉血氧分压均升高,但HFOV+NO组较HFOV组改善更显著(Pa<0.05)。HFOV+NO组上机时间(88.2±19.8)h,使用FiO2≥0.8时间(5.4±3.5)h;HFOV组上机时间(105.8±22.5)h,使用FiO2≥0.8时间(15.7±8.2)h。2组在上机时间、使用高浓度氧时间方面比较,差异均有统计学意义(Pa<0.05)。结论 HFOV联用NO吸入治疗新生儿气胸可迅速改善氧合,纠正低氧血症,缩短高浓度氧及呼吸机使用时间,提高抢救成功率。
Objective To investigate the effect of high frequency oscillatory ventilation (HFOV) combined with nitric oxide (NO) inhalation on neonatal pneumothorax. Methods Thirty-seven neonates with pneumothorax admitted from July 2003 to October 2008 in our hospital were examined by bed-side X-ray, which indicated that the lung tissue was compressed by more than 60%, and received pneumothorax after thoracocentesis Drainage and mechanical ventilation. 37 cases of pneumothorax were divided into two groups according to the different treatment methods: HFOV group and HFOV + NO group. In the HFOV group, 17 cases were treated with HFOV after mechanical pneumothorax. In the HFOV + NO group, 20 cases were treated with HFOV, NO was inhaled, and the NO level was (5-15) × 10-6.2 2 h, 12 h, 24 h and every 24 h after the blood gas analysis, and detailed records of ventilator parameters, calculate the oxygenation index (OI), continuous monitoring of NO / NO2 levels. Results Oxygenation continued to improve at 2 hours after treatment in both groups. The values of OI, FiO2 and mean airway pressure gradually decreased, while the partial pressure of arterial oxygen increased. However, HFOV + NO improved more significantly than HFOV (Pa <0.05). HFOV + NO group (88.2 ± 19.8) h, FiO2≥0.8 time (5.4 ± 3.5) h, HFOV group (105.8 ± 22.5) h, FiO2≥0.8 time (15.7 ± 8.2) h. There was significant difference between the two groups in the time of on-boarding and the time of using high-concentration oxygen (Pa <0.05). Conclusion HFOV combined with NO inhalation in the treatment of neonatal pneumothorax can rapidly improve oxygenation, correct hypoxemia, shorten the time of high concentration of oxygen and ventilator, and improve the success rate of rescue.