首选使用高频振荡通气治疗新生儿肺出血的临床效果分析

Clinical efficacy of preferred use of high-frequency oscillatory ventilation in treatment of neonatal pulmonary hemorrhage

摘要:

目的 探讨首选高频振荡通气(HFOV)治疗新生儿肺出血的有效性及安全性。方法 回顾性分析首选HFOV(首选组)和常频通气(CMV)治疗效果欠佳再换为HFOV 解救性治疗(解救组)肺出血患儿26 例的临床效果,比较两组患儿的氧合指数(OI)、肺出血时间、住院时间、上机时间、氧疗时间、合并症及转归变化。结果 首选组治疗后1、6、12、24、48、72 h OI 值明显低于解救组,差异有统计学意义(P<0.05)。首选组呼吸机相关性肺炎(VAP)发生率明显低于解救组(P<0.05),治愈率高于解救组(P<0.05)。首选组气胸、颅内出血、消化道出血的发生率与解救组比较差异无统计学意义(P>0.05)。存活患儿中,首选组在肺出血时间、住院时间、上机时间、氧疗时间上较解救组明显缩短(P<0.05)。结论 与解救组相比,首选HFOV 较解救性使用HFOV 能更好地改善肺出血患儿氧合功能,降低VAP 的发生率,缩短病程,提高治愈率,且未增加不良反应的发生率。

Abstract:

Objective To investigate the clinical efficacy and safety of preferred use of high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal pulmonary hemorrhage. Methods The clinical efficacy of preferred use of HFOV (preferred use group) and rescue use of HFOV after conventional mechanical ventilation proved ineffective (rescue use group) in the treatment of 26 cases of neonatal pulmonary hemorrhage was retrospectively analyzed. The oxygenation index (OI), pulmonary hemorrhage time, hospitalization time, ventilation time, oxygen therapy time, complications, and outcome of the two groups were compared. Results Compared with the rescue use group, the preferred use group had significantly lower IO values at 1, 6, 12, 24, 48, and 72 hours after treatment (P<0.05). Compared with the rescue use group, the preferred use group had a significantly lower incidence of ventilator associated pneumonia (VAP) (P<0.05) and a significantly higher cure rate (P<0.05). There were no statistically significant differences in the incidences of pneumothorax, intracranial hemorrhage, and digestive tract hemorrhage beween the two groups (P>0.05). Compared with those in the rescue use group, children who survived in the preferred use group had significantly shorter pulmonary hemorrhage time, hospitalization time, ventilation time, and oxygen therapy time (P<0.05). Conclusions Compared with the rescue use of HFOV, preferred use of HFOV can better improve oxygenation function, reduce the incidence of VAP, shorten the course of disease, and increase cure rate while not increasing the incidence of adverse effects.