新生儿呼吸衰竭的高频振荡通气时机及早期氧合参数监测意义的探讨

发布时间：2018-04-27 01:20

本文选题：高频振荡通气 + 治疗时机　；参考：《青岛大学》2013年硕士论文

【摘要】：目的探讨高频振荡通气(High-frequency oscillatory ventilation, HFOV)的治疗时机选择对新生几呼吸衰竭(Neonate respiratory failure, NRF)治疗效果的影响。方法收集青岛市妇女儿童医院新生儿重症监护室(NICU)2010年1月-2012年9月应用HFOV治疗的新生儿43例及烟台市毓璜顶医院NICU2010年8月-2012年12月应用HFOV治疗的新生儿31例。根据是否首先选用HFOV治疗,分为首选HFOV组和非首选HFOV组,搜集入选患儿的基本资料、评估患儿应用HFOV前的疾病严重程度、记录呼吸机使用情况,记录患儿应用HFOV前及治疗后2、6、12、24h的血气分析结果、呼吸机参数并计算氧合参数,观察并记录患儿的并发症、治愈率、死亡率、两组治愈患儿的住院时间及住院费用等。结果应用HFOV治疗的新生儿共74例,其中首选HFOV组22例,非首选HFOV组52例。两组应用呼吸机的原发病情况及应用HFOV治疗前的疾病严重程度无显著性差异,具有可比性。首选HFOV组吸入氧浓度(FiO2)0.6上机持续时间、上机总持续时间、撤HFOV后有创机械通气时间及无创通气时间、撤机后吸氧时间均比非首选HFOV组短,差异有显著性(t分别为-3.78、-2.87、-3.47、-2.03、-2.40,P均0.05)。两组患儿应用HFOV治疗后氧分压(Pa02)、二氧化碳分压(PaCO2)PH值均改善,差异有统计学意义(F分别为37.59、34.98、25.14,P均0.05),氧合指数(OI)、动脉肺泡氧分压比值(a/A)、肺泡-动脉氧分压差(A-aDO2)均好转,差异有显著性(F分别为32.54、41.09、25.89,P均0.05),平均气道压(MAP).Fi02下调顺利,有显著性差异(F分别为12.17、21.10,P均0.05),两组间比较差异无统计学意义。首选HFOV组比非首选HFOV且气胸发生率低,差异有显著性(X2=4.05,P0.05),在肺出血、颅内出血、支气管肺发育不良(BPD)、脑室周白质软化(PVL)等并发症方面无显著性差异。首选HFOV组22例,治愈14例(63.64%),死亡7例(31.82%)；非首选HFOV组52例,治愈23例(44.23%),死亡14例(26.92%),两组在死亡率上无差异。首选HFOV组比非首选HFOV组治愈患儿的住院时间短、住院费用低,差异有显著性。结论1.首选HFOV治疗新生儿呼吸衰竭总上机持续时间短,撤HFOV后的有创及无创机械通气时间缩短,减少了高浓度吸氧时间及撤机后吸氧时间。 2.首选HFOV治疗新生儿呼吸衰竭可降低气胸发生率。 3.首选HFOV治疗新生儿呼吸衰竭可以减少住院天数,降低住院费用。目的探讨高频振荡通气(HFOV)治疗的呼吸衰竭新生儿24h内动态氧合参数的变化及其对预后判断的价值。方法收集青岛市妇女儿童医院NICU2010年1月-2012年9月应用HFOV治疗的新生儿43例及烟台市毓璜顶医院NICU2010年8月-2012年12月应用HFOV治疗的新生儿31例。评估患儿应用HFOV治疗前及治疗后6、12h的呼吸窘迫评分。记录患儿应用HFOV前及治疗后2、6、12、24h的PH值、PaO2、PaCO2、MAP、FiO2,并计算各时段的a/A、OI、A-aDO2。结果共收集应用HFOV治疗的患儿74例,生存组53例,死亡组21例。两组应用HFOV治疗前呼吸窘迫评分无显著性差异,生存组治疗后6、12h呼吸窘迫评分与治疗前相比差异有显著性(t=10.82、14.51,P值均0.05),死亡组与治疗前比较无明显差异(P0.05)。应用HFOV后6、12h,生存组呼吸窘迫评分比死亡组低,差异有统计学意义(t=-11.25、-6.31,P0.05)。生存组HFOV治疗24h内PaO2、PaCO2、 PH、OI、a/A、A-aDO2明显改善,均较治疗前比较有差异(F分别为80.70、31.77、38.08、69.48、84.46、68.79, P均0.05),MAP、FiO2治疗后24h内与治疗前相比差异亦明显改善,有显著性差异(F分别38.99、56.80,P0.05)。虽然死亡组中应用HFOV2h后,PH较治疗前改善,差异有统计学意义(t=5.63,P0.05),应用HFOV6h后,PaCO2与治疗前相比,差异有显著性(t=8.43,P0.05),应用HFOV6、12h后,MAP与治疗前相比,差异有显著性(t=5.00、5.47,P值均0.05),但是死亡组应用HFOV后24h内,PaO2、PaCO2、PH、OI、a/A、A-aDO2、MAP、FiO2较治疗前无明显好转,总体差异无统计学意义。结论HFOV治疗的新生儿呼吸衰竭24h内动态氧合参数的监测可以帮助判断预后,但仍需结合临床实践。
[Abstract]:Objective to investigate the effect of the treatment timing of High-frequency oscillatory ventilation (HFOV) on the therapeutic effect of new respiratory failure (Neonate respiratory failure, NRF).
Methods to collect 43 newborns with HFOV treatment in the neonatal intensive care unit (NICU) of Qingdao women's and children's Hospital in September January 2010, and 31 newborns with HFOV treatment in Yuhuangding hospital, Yantai, August -2012 December. According to whether HFOV treatment was selected first, the first choice HFOV group and non preferred HFOV group were collected and collected. The children's basic data were selected to assess the severity of the disease before HFOV, record the use of the ventilator, record the results of the blood gas analysis before and after HFOV, the parameters of the ventilator and calculate the oxygenation parameters, observe and record the complications of the children, the cure rate, the death rate, and the two groups to cure the children's hospitalization time and stay. Hospital expenses and so on.
Results a total of 74 newborns were treated with HFOV, of which 22 were the first choice in group HFOV and 52 were not the first choice in group HFOV. There was no significant difference between the two groups and the severity of the disease before the application of HFOV. The first choice of the HFOV group inhaled oxygen concentration (FiO2) 0.6 on the duration of the machine, the total duration of the upper machine, and the HFOV after the withdrawal of HFOV. The time of mechanical ventilation and non invasive ventilation time were shorter than those in the non first HFOV group, and the difference was significant (t was -3.78, -2.87, -3.47, -2.03, -2.40, P 0.05 respectively). The two groups had improved oxygen partial pressure (Pa02) after HFOV treatment, and the pH value of carbon dioxide partial pressure (PaCO2) were improved. The difference was statistically significant (F was respectively, P 0.05), oxygenation index (OI), arterial alveolar oxygen partial pressure ratio (a/A), Alveolar arterial oxygen pressure difference (A-aDO2) were all improved, the difference was significant (F respectively 32.54,41.09,25.89, P 0.05), the average airway pressure (MAP).Fi02 downregulation was smooth, there were significant differences (F respectively 12.17,21.10, P are 0.05), the two groups had no statistical difference. Preferred There were significant differences in the incidence of HFOV and pneumothorax (X2=4.05, P0.05). There were no significant differences in the complications of pulmonary hemorrhage, intracranial hemorrhage, bronchopulmonary dysplasia (BPD) and periventricular white matter softening (PVL). The first choice HFOV group was 22 cases, 14 cases were cured (63.64%), 7 cases died (31.82%), 52 cases of non preferred HFOV group, 23 cases (44.23%) cured (44.23%), death. 14 cases (26.92%) died. There was no difference in mortality between the two groups. The first group HFOV was shorter than the non preferred HFOV group, and the hospitalization time was shorter and the hospitalization expenses were lower.
Conclusion 1. the first choice of HFOV in the treatment of neonatal respiratory failure is short, and the duration of invasive and noninvasive mechanical ventilation after the withdrawal of HFOV reduces the time of high concentration of oxygen inhalation and the time of oxygen inhalation after the withdrawal of the machine.
2. the first choice of HFOV is to reduce the incidence of pneumothorax in the treatment of neonatal respiratory failure.
3. the first choice of HFOV treatment of neonatal respiratory failure can reduce hospitalization days and reduce hospitalization expenses.
Objective to investigate the changes of dynamic oxygenation parameters in 24h of neonates with respiratory failure treated by high frequency oscillatory ventilation (HFOV) and their prognostic value.
Methods 43 newborns who were treated with HFOV in Qingdao women's and children's Hospital, January -2012 years, and 31 neonates with HFOV treatment in December August -2012 in Yuhuangding hospital, Yantai, were collected. The respiratory distress scores of 6,12h before and after HFOV treatment were evaluated. The children were used before and after the treatment of 2,6, 12,24h's pH, PaO2, PaCO2, MAP, FiO2, and calculate a/A, OI, A-aDO2. of each period.
Results 74 children were treated with HFOV, 53 cases in survival group and 21 cases in death group. There was no significant difference in the respiratory distress score of the two groups before treatment. The 6,12h respiratory distress score in the survival group was significantly different from that before the treatment (t=10.82,14.51, P value was 0.05), and there was no significant difference between the death group and the pre treatment group (P0.05). After HFOV 6,12h, the respiratory distress score in the survival group was lower than that in the death group. The difference was statistically significant (t=-11.25, -6.31, P0.05). HFOV in the survival group was significantly improved in 24h PaO2, PaCO2, PH, OI, a/A. The difference was significantly improved (F 38.99,56.80, P0.05). Although after the application of HFOV2h in the death group, the difference was statistically significant (t=5.63, P0.05). After the application of HFOV6h, the difference was significant (t=8.43, P0.05) compared with before the treatment (t=8.43, P0.05). After the application of HFOV6,12h, there was a significant difference. 0,5.47 and P values were all 0.05), but in the death group after HFOV, 24h, PaO2, PaCO2, PH, OI, a/A, A-aDO2, MAP, and MAP had no significant improvement compared with those before treatment, and the overall difference was not statistically significant.
Conclusion monitoring of dynamic oxygenation parameters in 24h of neonatal respiratory failure treated with HFOV can help to predict prognosis, but it still needs to be combined with clinical practice.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R722.1

【参考文献】