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目的比较高频震荡通气(HFOV)与常频通气(CMV)在重症新生儿呼吸窘迫综合征(RDS)治疗中的效果和安全性。方法选取2012年3月至2013年2月广东省妇幼保健院NICU收治的Ⅲ、Ⅳ级RDS早产儿,根据入院时机械通气方式不同分为HFOV组和间歇指令机械通气(IMV)组,记录两组治疗前后各时点(0、2、12、24 h)氧合指数(OI)、二氧化碳分压(Pa CO2);同时记录两组患儿机械通气时间及氧暴露时间;治疗过程中并发症发生率及病死率;校正月龄18个月脑性瘫痪发生率及智力-运动发育商(DQ)。结果共纳入106例重症RDS早产儿,其中HFOV组52例,IMV组54例,93例完成了校正月龄18个月时神经康复科随访,其中HFOV组47例,IMV组46例。机械通气2、12、24 h,HFOV组OI低于IMV组[2 h:(14.8±4.2)比(26.6±3.6),12 h:(11.6±3.1)比(15.9±3.5),24 h:(10.6±3.3)比(14.8±3.3)];机械通气2、12 h,HFOV组Pa CO2(mm Hg)低于IMV组[2 h:(36.9±8.9)比(42.8±9.1),12 h:(35.8±8.3)比(41.7±7.5)],差异有统计学意义(P<0.05);两组机械通气2 h与同组0 h相比,OI及Pa CO2均降低(P<0.05)。HFOV组有创和无创机械通气时间(h)、氧暴露时间(h)、肺气漏及BPD发生率明显低于IMV组[有创:(74.3±41.3)比(98.6±32.4),无创:(38.3±22.5)比(56.9±37.5),氧暴露:(152.5±33.4)比(190.4±28.4),肺气漏:1.9%比5.6%,BPD:1.9%比7.4%,P<0.05];两组病死率、脑出血发生率、校正月龄18个月脑性瘫痪发生率、DQ等差异均无统计学意义(P>0.05)。结论与IMV方式相比,HOFV治疗重症新生儿RDS安全、有效,能迅速改善患儿肺部氧合,减少严重并发症发生率,且不会影响患儿远期运动-智力发育。
Objective To compare the efficacy and safety of high frequency oscillatory ventilation (HFOV) and frequent ventilatory ventilation (CMV) in the treatment of severe neonatal respiratory distress syndrome (RDS). Methods Preterm infants with grade III and IV RDS admitted to NICU of Guangdong MCH hospital from March 2012 to February 2013 were selected and divided into HFOV group and intermittent mandatory mechanical ventilation (IMV) group according to different types of mechanical ventilation at admission. The oxygenation index (OI) and the partial pressure of carbon dioxide (Pa CO2) at each time point (0, 2, 12, 24 h) before and after treatment were recorded. The mechanical ventilation time and oxygen exposure time were also recorded in both groups. Incidence and mortality; correction of 18-month-old cerebral palsy incidence and mental-motor development (DQ). Results A total of 106 severe preterm infants with RDS were enrolled. Among them, 52 were in HFOV group and 54 were in IMV group. Ninety-three patients were followed up for neurology and rehabilitation at 18 months of age, including 47 in HFOV group and 46 in IMV group. Mechanical ventilation 2,12,24 h, OI in HFOV group was lower than IMV group [2 h: (14.8 ± 4.2) vs (26.6 ± 3.6), 12 h: (11.6 ± 3.1) vs (15.9 ± 3.5) (10.6 ± 3.3) vs (14.8 ± 3.3)]; PaCO 2 (mm Hg) in HFOV group was lower than that in IMV group at 2 h and 12 h after mechanical ventilation [2 h: (36.9 ± 8.9) : (35.8 ± 8.3) vs (41.7 ± 7.5)], the difference was statistically significant (P <0.05). Compared with the same group at 0 h, both OI and Pa CO2 decreased . The incidence of invasive and noninvasive mechanical ventilation (h), oxygen exposure time (h), air leak and BPD in HFOV group were significantly lower than those in IMV group [invasive: (74.3 ± 41.3) vs (98.6 ± 32.4) (38.3 ± 22.5) vs (56.9 ± 37.5), oxygen exposure: (152.5 ± 33.4) vs (190.4 ± 28.4), pulmonary leakage: 1.9% vs 5.6%, BPD: 1.9% vs 7.4%, P <0.05; There was no significant difference between the two groups in the mortality rate, the incidence of cerebral hemorrhage, the incidence of cerebral palsy at 18 months of correction, and DQ (P> 0.05). Conclusions Compared with IMV, HOFV is safe and effective in the treatment of severe neonatal RDS. It can rapidly improve lung oxygenation and reduce the incidence of serious complications in children, and will not affect the long-term development of children with mental retardation.