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目的研究新生儿气胸的机械通气治疗效果。方法选取天津市儿童医院新生儿科2007年12月-2009年10月收治的40例气胸新生儿,应用呼吸机、吸入氧体积分数(FiO2)>50%才能维持动脉氧分压[pa(O2)]≥6.65 kPa,动脉血氧分压/肺泡氧分压(a/APO2)<0.22。40例患儿分别采用常频通气(常频组,n=20)和高频振荡通气(高频组,n=20)并胸腔闭式引流治疗。观察治疗前后2组新生儿血pH值、氧分压、二氧化碳分压、氧合指数、呼吸指数等指标的变化及平均呼吸机使用时间、胸片恢复正常时间、预后等临床疗效。结果治疗8 h,高频组pa(O2)由(5.43±2.45)kPa升高至(9.62±1.34)kPa,氧合指数由122.1±14.3升至182.3±31.6,呼吸指数由3.96±0.49降至1.71±0.73;治疗48 h,pa(O2)达到(11.36±1.38)kPa,氧合指数为231.4±35.9,呼吸指数为1.01±0.31。常频组与高频组血气分析指标及氧合指数、呼吸指数等肺功能变化比较差异具有统计学意义(Pa<0.05),高频组在肺功能改善方面要优于常频组。呼吸机使用时间:高频组为(3.4±1.1)d,常频组为(6.8±1.2)d,2组比较差异有统计学意义(t=2.954,P<0.01)。胸片恢复正常时间:高频组为(3.9±1.7)d,常频组为(9.3±2.1)d,2组比较差异有统计学意义(t=2.826,P<0.01)。高频组痊愈19例,无效1例;常频组痊愈12例,无效8例,2组疗效比较差异有统计学意义(χ2=5.16,P<0.05)。平均呼吸机使用时间、胸片恢复正常时间、预后比较等方面高频组要优于常频组。结论新生儿气胸机械通气治疗应首选高频振荡通气。
Objective To study the effect of mechanical ventilation on neonatal pneumothorax. Methods Forty neonates with pneumothorax were admitted to Department of Neonatology, Children’s Hospital of Tianjin from December 2007 to October 2009. Venous oxygen tension (PAO2) was maintained by using ventilator and inhalation volume fraction (FiO2)> 50% ] ≥6.65 kPa, arterial partial pressure of oxygen / alveolar oxygen pressure (a / APO2) <0.22.40 cases of children were treated with frequent ventilation (normotensive group, n = 20) and high frequency oscillating ventilation , n = 20) and closed thoracic drainage therapy. Changes of blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, oxygenation index, respiration index and mean time of ventilator, recovery time of chest X-ray and prognosis were observed before and after treatment. Results After 8 h of treatment, the pa (O2) increased from (5.43 ± 2.45) kPa to (9.62 ± 1.34) kPa in high frequency group, and the oxygenation index increased from 122.1 ± 14.3 to 182.3 ± 31.6. The respiratory index decreased from 3.96 ± 0.49 1.71 ± 0.73; Pa (O2) reached (11.36 ± 1.38) kPa, oxygenation index was 231.4 ± 35.9 and respiratory index was 1.01 ± 0.31 at 48 h after treatment. The frequency of blood gas analysis and oxygenation index, respiration index and other lung function changes were significantly different between the two groups (P <0.05). The high-frequency group was better than the normal-frequency group in improving pulmonary function. The duration of ventilator use was (3.4 ± 1.1) days in high frequency group and (6.8 ± 1.2) days in constant frequency group, the difference was statistically significant (t = 2.954, P <0.01). The duration of chest X-ray recovery was (3.9 ± 1.7) days in high frequency group and (9.3 ± 2.1) days in constant frequency group, there was significant difference between the two groups (t = 2.826, P <0.01). 19 cases were cured in high-frequency group, 1 case was ineffective; 12 cases were cured in normal frequency group and 8 cases were ineffective. There was significant difference in curative effect between two groups (χ2 = 5.16, P <0.05). Average ventilator time, chest X-ray time to normal, prognosis and other aspects of high-frequency group is better than normal frequency group. Conclusion Neonatal pneumothorax mechanical ventilation should be the preferred high-frequency oscillatory ventilation.