目的 分析在肺表面活性物质(PS)给药过程中联合不同通气方式对重症新生儿呼吸窘迫综合征(RDS)的临床疗效,为临床诊治提供参考依据。方法 2015年12月—2017年5月收集65例符合纳入标准RDS早产儿,其中手动通气组32例,高频通气组33例,回顾性分析两组患儿气管内注入PS经皮氧分压(tcPO2)和二氧化碳分压(tcPCO2)变化、氧合指数(OI)、呼吸指数(RI)、胸部X线改善情况、机械通气时间及相关并发症。结果 PS给药时两组均出现短暂tcPO2降低、tcPCO2升高,给药后tcPO2快速升高、tcPCO2降低,手动通气组比高频通气组变化显著且持续时间长,差异有统计学意义(P＜0.05)。在5～15 min时二者达到稳定状态,高频通气组先于手动通气组; 1 h时高频通气组OI、RI均低于手动通气组,差异均有统计学意义(P＜0.05)。高频通气组PS后X线表现显著改善,且机械通气时间低于手动通气组,差异均具有统计学意义(P＜0.05)。两组患儿并发症(脑室内出血、支气管肺发育不良、气漏综合征)发生率比较差异无统计学意义(P＞0.05)。结论 高频振荡通气下气管内注入PS可更显著减少tcPO2、tcPCO2波动;更有效改善重症RDS新生儿肺顺应性和氧合功能,缩短机械通气时间。
Abstract
Objective To analyze the effects of different ventilation methods during pulmonary surfactant(PS) administration on the treatment of severe neonatal respiratory distress syndrome(RDS),in order to provide reference for the treatment of RDS. Methods A total of 65 preterm infants who met the inclusion criteria were enrolled in this study,and were divided into manual ventilation group(n=32) and high frequency ventilation group(n=33).The changes of percutaneous partial pressure of O2(tcPO2) and CO2(tcPCO2),oxygenation index(OI)and respiratory index(RI) during PS administration were retrospectively analyzed,and the chest X-ray situation,mechanical ventilation time and related complications were also compared. Results During administration,tcPO2 transiently decreased and tcPCO2 increased.After administration,tcPO2 rapidly increased,tcPCO2 decreased in both groups.The changes of manual ventilation group were more obvious and had longer duration time(P＜0.05).Also,tcPO2 and tcPCO2 reached steady till 5 minutes to 15 minutes after PS administration,the high frequency ventilation group was earlier than the manual ventilation group(P＜0.05).At 1 hour,the high frequency ventilation group had lower OI and RI than the manual ventilation group(P＜0.05).The high frequency ventilation group had more conspicuous improvement of X-ray,shorter duration of mechanical ventilation than the manual ventilation group(P＜0.05).There were no significant differences on the complication incidence (intraventricular hemorrhage,bronchopulmonary dysplasia,air leak syndrome) (P＞0.05) between the two groups. Conclusion High frequency oscillatory ventilation during endotracheal PS injection can significantly reduce tcPO2,tcPCO2 fluctuation,and improve the neonatal pulmonary compliance and oxygenation in severe RDS neonates more effectively,thereby shortening the duration time for mechanical ventilation.
关键词
早产儿 /
呼吸窘迫综合征 /
肺表面活性物质 /
高频振荡通气
Key words
preterm infants /
respiratory distress syndrome /
pulmonary surfactant /
high frequency oscillatory ventilation
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Liu L,Oza S,Hogan D,et al. Global,regional,and national causes of child mortality in 2000-2013,with projections to inform post-2015 priorities:an updated systematic analysis[J]. Lancet,2015,385(9966):430-440.
[2] Sweet DG,Carnielli V,Greisen G,et al. European consensus guidelines on the management of respiratory distress syndrome-2016 Update[J].Neonatology,2016,111(2):107-125.
[3] Polin RA,Carlo WA, Committee on Fetus and Newborn. Surfactant replacement therapy for preterm and term neonates with respiratory distress[J]. Pediatrics,2014,133:156-163.
[4] Miedema M,de Jongh FH,Frerichs I,et al. Changes in lung volume and ventilation during surfactant treatment in ventilated preterm infants[J]. Am J Respir Crit Care Med,2011,184:100-105.
[5] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011:440-443.
[6] 付芳,汪金秀,连冬梅.肺表面过性物质治疗新生儿呼吸窘迫综合征给药方法的改进[J].实用临床医学,2013,l4(4):80-81.
[7] 李茂军,吴青,陈昌辉,等.不同胎龄新生儿呼吸窘迫综合征临床特征分析[J].中国当代儿科杂志,2016,18(10):960-964.
[8] Nina N,Alicia LR,Marisa L,et al. Surfactant administration in neonates:a review of delivery methods[J]. Can J Respir Ther,2014,50(3):91-95.
[9] Vento G,Tana M,Tirone C,et al. Efficacy of exogenous surfactant during conventional and high-frequency oscillatory ventilation in preterm infants with RDS[J]. Acta Biomed,2013,84(Suppl 1):25-27.
[10] 高建军,彭清云,王林华,等.经皮氧分压和二氧化碳分压监测在急性呼吸衰竭患者中的应用研究[J].交通医学,2016,30(2):141-143.
[11] Roll C,Knief J,Horsch S,et a1. Effect of surfactant administration on cerebral haemodynamics and oxygenation in premature infants--a near infrared spectroscopy study[J]. Neuropediatrics,2000,31(1):16-23.
[12] Vesoulis A,Liao M,Trivedi B,et a1.A novel method for assessing cerebral autoregulation in preterm infants using transfer function analysis[J].Pediatr Res,2016,79(3):453-459.
[13] Marini JJ. Mechanical ventilation:past lessons and the near future[J].Critical Care,2013,17(Suppl 1):1.
PDF(667 KB)
