高频振荡通气、肺表面活性物质联合一氧化氮吸入治疗新生儿低氧性呼吸衰竭的临床研究

Clinical effect of combination therapy with high-frequency oscillation ventilation, pulmonary surfactant and inhaled nitric oxide in the treatment of neonatal hypoxemic respiratory failure

摘要:

目的 探讨用高频振荡通气（HFOV）、肺表面活性物质（PS）联合一氧化氮吸入（iNO）治疗新生儿低氧性呼吸衰竭（HRF）的疗效。方法 116例HRF患儿随机分为三联组和二联组，各58例。三联组采用HFOV、PS联合iNO治疗；二联组采用HFOV 联合iNO治疗。观察两组患儿治疗前及治疗后24 h、48 h的血气分析、PaO₂/FiO₂（P/F）、OI值和肺动脉压力（PA）的变化，比较不同P/F值、OI值和是否合并PPHN患儿的治疗结局。结果 三联组的上机时间和iNO治疗时间均短于二联组（P<0.01），且治疗后24 h、48 h的血气指标PaO₂ 、PaCO₂均优于二联组（P<0.01）。三联组合并PPHN的患儿治疗后24 h、48 h的PA值均较二联组下降明显（P<0.01）。在P/F值≤50的病例中，三联组的治愈率优于二联组（P<0.05）；两组死亡者的P/F值均低于存活者（P<0.01）。在OI值≥40的病例中，三联组的治愈率优于二联组（P<0.05）；两组死亡者的OI值均高于存活者（P<0.01）。三联组合并PPHN患儿治愈率优于二联组（P<0.05）。三联组住院时间较二联组缩短（P<0.01）。三联组总治愈率高于二联组（P<0.05）。两组患儿并发症发生率比较差异无统计学意义（P >0.05）。治疗中两组均未监测到严重不良反应。结论 HFOV、PS和iNO三联治疗较HFOV和iNO二联治疗新生儿HRF更为有效，可显著改善氧合，提高患儿的存活率，尤其是为患严重肺部疾病合并PPHN，且P/F值≤50或OI值≥40的病情极危重患儿提供了一个新的治疗手段。

Abstract:

Objective To investigate the clinical effect of combination therapy with high-frequency oscillation ventilation (HFOV), pulmonary surfactant (PS) and inhaled nitric oxide (iNO) in the treatment of neonatal hypoxemic respiratory failure (HRF). Methods A total of 116 neonates with HRF were studied, and they were randomly divided into two groups: triple therapy (n=58) and dual therapy (n=58). The triple therapy group received HFOV, PS, and iNO, while the dual therapy group received HFOV and iNO. Blood gas values, PaO₂/FiO₂ (P/F), oxygenation index (OI), and pulmonary arterial pressure (PA) were determined before treatment and after 24 and 48 hours of treatment. Among the neonates with different P/F ratios and OI values and with or without persistent pulmonary hypertension of the newborn (PPHN), the treatment outcomes of two groups were compared. Results The durations of mechanical ventilation and iNO therapy in the triple therapy group were significantly shorter than in the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the triple therapy group had significantly improved PaO₂ and PaCO₂ compared with the dual therapy group (P<0.01). After 24 and 48 hours of treatment, the neonates with PPHN in the triple therapy group had significantly decreased PA compared with the dual therapy group (P<0.01). In the cases with a P/F ratio of ≤50, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the P/F ratios of the neonates who died were significantly lower than those of survivors (P<0.01). In the cases with an OI of ≥40, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). In both groups, the OI values of the neonates who died were significantly higher than those of survivors (P<0.01). In neonates with PPHN, the triple group had a significantly higher cure rate than the dual therapy group (P<0.05). The triple therapy group had a significantly shorter length of hospital stay (P<0.01) and a significantly higher cure rate (P<0.05) compared with the dual therapy group. There were no significant differences in complications between the two groups (P >0.05). No severe side effect was found during the treatment in either group. Conclusions Triple therapy with HFOV, PS and iNO is a more effective treatment for neonatal HRF compared with the dual therapy with HFOV and iNO. The triple therapy can significantly improve oxygenation and survival rate, providing a new treatment for the neonates with HRF, especially the critical cases who suffer severe lung disease with PPHN and have a P/F ratio of ≤50 or an OI of ≥40.