容量保证的高频振荡通气模式对胎龄28~34周早产儿呼吸衰竭疗效的前瞻性随机对照研究

Therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation on respiratory failure in preterm infants with a gestational age of 28-34 weeks: a prospective randomized controlled study

摘要:

目的 探讨容量保证的高频振荡通气（volume-guaranteed high frequency oscillation ventilation, HFOV-VG）与常频机械通气（conventional mechanical ventilation, CMV）治疗早产儿呼吸衰竭的疗效差异。方法 前瞻性纳入2018年10月—2022年12月东南大学医学院附属江阴医院新生儿科住院的112例呼吸衰竭早产儿（胎龄28~34周）为研究对象，采用掷硬币法基于机械通气模式随机分为HFOV-VG组（44例）和CMV组（68例），比较两种通气模式的治疗效果。结果 HFOV-VG组和CMV组治疗24 h后动脉血pH、氧分压、二氧化碳分压及氧分压/吸入气氧浓度均较治疗前改善（P<0.05），且HFOV-VG组改善效果优于CMV组（P<0.05）。两组早产儿并发症、28 d病死率、住院时长比较差异无统计学意义（P>0.05），但HFOV-VG组有创机械通气时间短于CMV组（P<0.05）。随访至纠正6月龄，两组早产儿小儿神经心理发育量表的发育商、大运动、精细动作、适应能力、语言、社会行为得分差异无统计学意义（P>0.05）。结论 HFOV-VG模式较CMV模式能够更快提高氧分压、促进二氧化碳排出，从而改善呼吸衰竭早产儿的氧合、缩短呼吸机使用时间，对患儿短期神经行为发育无显著影响。

Abstract:

Objective To investigate the therapeutic efficacy of volume-guaranteed high frequency oscillation ventilation (HFOV-VG) versus conventional mechanical ventilation (CMV) in the treatment of preterm infants with respiratory failure.Methods A prospective study was conducted on 112 preterm infants with respiratory failure (a gestational age of 28-34 weeks) who were admitted to the Department of Neonatology, Jiangyin Hospital Affiliated to Medical School of Southeast University, from October 2018 to December 2022. The infants were randomly divided into an HFOV-VG group (44 infants) and a CMV group (68 infants) using the coin tossing method based on the mode of mechanical ventilation. The therapeutic efficacy was compared between the two groups.Results After 24 hours of treatment, both the HFOV-VG and CMV groups showed significant improvements in arterial blood pH, partial pressure of oxygen, partial pressure of carbon dioxide, and partial pressure of oxygen/fractional concentration of inspired oxygen ratio (P<0.05), and the HFOV-VG group had better improvements than the CMV group (P<0.05). There were no significant differences between the two groups in the incidence rate of complications, 28-day mortality rate, and length of hospital stay (P>0.05), but the HFOV-VG group had a significantly shorter duration of invasive mechanical ventilation than the CMV group (P<0.05). The follow-up at the corrected age of 6 months showed that there were no significant differences between the two groups in the scores of developmental quotient, gross motor function, fine motor function, adaptive ability, language, and social behavior in the Pediatric Neuropsychological Development Scale (P>0.05).Conclusions Compared with CMV mode, HFOV-VG mode improves partial pressure of oxygen and promotes carbon dioxide elimination, thereby enhancing oxygenation and shortening the duration of mechanical ventilation in preterm infants with respiratory failure, while it has no significant impact on short-term neurobehavioral development in these infants.