不同机械通气方式联合肺表面活性物质对新生儿急性肺损伤/急性呼吸窘迫综合征疗效比较

Clinical effects of different ways of mechanical ventilation combined with pulmonary surfactant in treatment of acute lung injury/acute respiratory distress syndrome in neonates:a comparative analysis

摘要:

目的 比较高频振荡通气+肺表面活性物质 （HFOV+PS）、常频机械通气+肺表面活性物质 （CMV+PS）、常频机械通气 （CMV）3种治疗方式对新生儿急性肺损伤/急性呼吸窘迫综合征 （ALI/ARDS）的临床疗效。方法 纳入ALI/ARDS新生儿136例 （ALI73例，ARDS63例），其中HFOV+PS组45例，CMV+PS组53例，CMV组38例，前两组应用肺表面活性物质气管内滴入 （70~100mg/kg）。分别检测机械通气0h、12h、24h、48h、72h的PaO₂、PaCO₂、PaO₂/FiO₂、氧合指数 （OI）、呼吸指数 （RI）。结果 机械通气12h、24h、48h时HFOV+PS组的PaO₂高于CMV+PS组和CMV组，PaCO₂低于CMV+PS组和CMV组 （P < 0.05）；在机械通气12h、24h、48h、72h时HFOV+PS组PaO₂/FiO₂高于CMV+PS组和CMV组，OI、RI低于CMV+PS组和CMV组 （P < 0.05）；HFOV+PS组机械通气时间、用氧时间均低于CMV+PS组和CMV组 （P < 0.05）；3组气漏、颅内出血发生率及治愈率比较差异无统计学意义。结论 与单纯CMV以及CMV联合PS治疗相比，HFOV联合PS更可改善ALI/ARDS新生儿的肺功能，缩短通气时间及用氧时间，且不增加并发症的发生。

Abstract:

Objective To compare the therapeutic effects of high-frequency oscillatory ventilation+pulmonary surfactant (HFOV+PS), conventional mechanical ventilation+pulmonary surfactant (CMV+PS), and conventional mechanical ventilation (CMV) alone for acute lung injury/acute respiratory distress syndrome (ALI/ARDS) in neonates. Methods A total of 136 neonates with ALI/ARDS were enrolled, among whom 73 had ALI and 63 had ARDS. They were divided into HFOV+PS group (n=45), CMV+PS group (n=53), and CMV group (n=38). The neonates in the first two groups were given PS at a dose of 70-100 mg/kg. The partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), PaO₂/fraction of inspired oxygen (FiO₂), oxygenation index (OI), and respiratory index (RI) were measured at 0, 12, 24, 48, and 72 hours of mechanical ventilation. Results At 12, 24, and 48 hours of mechanical ventilation, the HFOV+PS group had higher PaO₂ and lower PaCO₂ than the CMV+PS and CMV groups (P < 0.05). At 12, 24, 48, and 72 hours of mechanical ventilation, the HFOV+PS group had higher PaO₂/FiO₂ and lower OI and RI than the CMV+PS and CMV groups (P < 0.05). The HFOV+PS group had shorter durations of mechanical ventilation and oxygen use than the CMV+PS and CMV groups (P < 0.05). There were no significant differences in the incidence rates of air leakage and intracranial hemorrhage and cure rate between the three groups. Conclusions In neonates with ALI/ARDS, HFOV combined with PS can improve pulmonary function more effectively and shorten the durations of mechanical ventilation and oxygen use compared with CMV+PS and CMV alone. It does not increase the incidence of complications.