高频振荡通气联合肺表面活性物质治疗新生儿肺出血的疗效观察

Clinical efficacy of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal pulmonary hemorrhage

摘要:

目的 探讨高频振荡通气(HFOV)联合肺表面活性物质(PS)治疗新生儿肺出血(NPH)的临床疗效。方法 将2010 年1 月至2014 年6 月确诊为NPH 的122 例患儿,按胎龄分层后,随机分为HFOV+PS 治疗组(简称试验组)和单纯HFOV 治疗组(简称对照组),每组61 例。两组患儿均在发生NPH 后行HFOV,试验组在行HFOV 后2~4 h 给予气管内注入PS,然后继续HFOV。观察两组患儿上机时及上机后6、12、24 h 的血气分析、OI 值、PaO₂/FiO₂(P/F)值的动态变化,比较两组患儿的肺出血时间、上机时间、并发症和治愈率。结果 试验组在上机后6、12、24 h 的PaO₂、PaCO₂、OI 值、PaO₂/FiO₂(P/F)值均要优于对照组(P<0.05);试验组的肺出血停止时间及上机时间均短于对照组(P<0.01),且并发症发生率低于对照组(P<0.05);试验组治愈率(87%)与对照组(82%)相比差异无统计学意义(P>0.05)。结论 HFOV 联合PS 治疗NPH 可以改善氧合,缩短NPH 时间及上机时间,减少并发症的发生,但与单纯HFOV 相比并不能降低病死率。

Abstract:

Objective To explore the clinical efficacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH). Methods A total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratified by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO₂/FiO₂ (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups. Results After 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO₂, PaCO₂, O/I, and P/F values compared with the control group (P<0.05). The time to hemostasis and the duration of ventilation were significantly shorter in the treatment group than in the control group (P<0.01), and the incidence of complications was lower in the former than in the latter (P<0.05). There was no significant difference in the cure rate between the treatment (87%) and control (82%) groups (P>0.05). Conclusions HFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.