高频振荡通气与机械通气治疗新生儿呼吸衰竭疗效比较

发布时间：2018-06-06 09:26

本文选题：高频振荡通气 + 机械通气　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的比较高频振荡通气和传统机械通气治疗新生儿呼吸衰竭的治疗效果。方法选取2011年10月至2013年12月来我院新生儿重症监护病房（NICU）进行住院治疗的呼吸衰竭患儿112例，分为高频振荡通气治疗组（HFOV组）和传统机械通气治疗组（CMV组）。两组患儿在给予相同抗生素进行抗感染和营养支持治疗的基础上，分别给予高频振荡通气治疗和传统机械通气治疗，观察两组患儿治疗前后平均动脉压、心率、氧分压（PaO2）、氧饱和度（SaO2）和二氧化碳分压（PaCO2）等指标的变化，比较两种方法治疗6h、12h、24h后患儿氧浓度（FiO2）、氧合指数（OI）和动脉肺泡氧分压比(a/APaO2)的差异，以及治疗后的并发症及转归情况。结果高频振荡通气和传统机械通气对呼吸衰竭患儿治疗前后平均动脉压和心率无显著的改变（P0.05）；与治疗前相比，高频振荡通气治疗组和机械通气治疗组治疗后氧分压（PaO2）和氧饱和度（SaO2）均显著升高，差异有统计学意义（P0.05），，且与传统机械通气治疗组相比，应用高频振荡通气治疗后氧分压（t=2.97，P0.05）和氧饱和度（t=2.66，P0.05）升高更显著，差异具有明显的统计学意义；与治疗前相比，两种方法治疗后二氧化碳分压（PaCO2）均明显降低，统计学差异显著（P0.05），且与传统机械通气治疗组相比，应用高频振荡通气治疗后二氧化碳分压降低更显著（t=4.5，P0.05），差异具有统计学意义。对应用高频振荡通气和传统机械通气治疗后呼吸衰竭患儿肺氧合功能的比较发现，治疗前两组患儿在氧浓度（FiO2）、氧合指数（OI）和动脉肺泡氧分压比(a/APaO2)方面无差异（P0.05）；与治疗前相比，传统机械通气治疗后6h氧浓度（FiO2）降低（P0.05），12h、24h后降低效果更显著（P0.05），呈现时间依赖性；而高频振荡通气治疗后与治疗前相比降低更明显（P0.05），且与传统机械通气治疗组相比，在治疗后同一时间高频振荡通气组氧浓度（FiO2）较低，6h、12h、24h两组比较分别为（t=5.04，P0.05）、（t=5.6，P0.05）、（t=6.84，P0.05），差异有统计学意义；与治疗前相比，传统机械通气治疗后6h氧合指数（OI）明显降低（P0.05），12h、24h后降低更显著（P0.05），呈现时间依赖性；高频振荡通气治疗后与治疗前相比降低更明显（P0.05），也呈现时效依赖关系，且与传统机械通气治疗组相比，在治疗后同一时间高频振荡通气组氧合指数（OI）较低，6h、12h、24h两组比较分别为（t=3.35，P0.05）、（t=4.56，P0.05）、（t=5.41，P0.05），差异具有统计学意义；与治疗前相比，传统机械通气治疗后6h动脉肺泡氧分压比(a/A PaO2)明显升高（P0.05），12h、24h后升高更显著（P0.05），呈现时间依赖性；高频振荡通气治疗后与治疗前相比升高更明显（P0.05），也呈现时效依赖关系，且与传统机械通气治疗组相比，在治疗后同一时间高频振荡通气组动脉肺泡氧分压比(a/APaO2)较高，6h、12h、24h两组比较分别为（t=7.82，P0.05）、（t=3.69，P0.05）、（t=2.78，P0.05），差异具有统计学意义；高频振荡通气治疗组和传统机械通气治疗组在并发颅内出血和呼吸机相关性肺炎方面无显著差异（P0.05），但相比高频振荡通气治疗组，传统机械通气治疗组气胸发生率明显增高，差异具有统计学意义（P0.05），高频振荡通气治俞率明显高于传统机械通气，差异具有统计学意义（P0.05）。结论相比传统机械通气，高频振荡通气改善肺通气、肺换气以及氧合功能效果更明显，可明显提高治愈率、减少并发症、降低死亡率。
[Abstract]:Objective To compare the effects of high frequency oscillatory ventilation and traditional mechanical ventilation on neonatal respiratory failure .

Methods 112 patients with respiratory failure hospitalized in the neonatal intensive care unit ( NICU ) from October 2011 to December 2013 were divided into high frequency oscillatory ventilation therapy group ( HFOV group ) and traditional mechanical ventilation treatment group ( CMV group ) . The changes of mean arterial pressure , heart rate , oxygen partial pressure ( PaCO 2 ) , oxygen saturation ( SaO2 ) and carbon dioxide partial pressure ( PaCO 2 ) were observed in two groups . The difference of oxygen concentration ( FiO2 ) , oxygenation index ( OI ) and pulmonary alveolar oxygen partial pressure ratio ( a / APaO2 ) were compared between two groups .

Results High - frequency oscillatory ventilation and traditional mechanical ventilation had no significant changes in mean arterial pressure and heart rate before and after treatment ( P0.05 ) .
Compared with the traditional mechanical ventilation therapy group , the difference was significant ( P0.05 ) , and the oxygen partial pressure ( t = 2.97 , P0.05 ) and oxygen saturation ( t = 2.66 , P0.05 ) were higher than those in the traditional mechanical ventilation treatment group .
Compared with the traditional mechanical ventilation therapy group , there was no significant difference between the two methods ( P0.05 ) . Compared with the traditional mechanical ventilation treatment group , there was no significant difference between the two groups ( t = 4.5 , P0.05 ) . The difference of the oxygen concentration ( FiO2 ) , the oxygen index ( OI ) and the pulmonary alveolar oxygen partial pressure ( a / APaO2 ) was not significant in the two groups before treatment ( P0.05 ) .
Compared with the prior therapy , the oxygen concentration ( FiO2 ) decreased ( P0.05 ) , 12h and 24h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time dependence was presented .
Compared with the traditional mechanical ventilation treatment group , the oxygen concentration ( FiO2 ) of high frequency oscillation ventilation group was lower at the same time after treatment ( P0.05 ) , and the difference was significant ( t = 5.06 , P0.05 ) , ( t = 6.84 , P0.05 ) .
Compared with the prior therapy , the oxygenation index ( OI ) was significantly decreased ( P0.05 ) , 12 h and 24 h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time dependence was presented .
Compared with the traditional mechanical ventilation therapy group , the oxygenation index ( OI ) of high frequency oscillatory ventilation group was lower , 6h , 12h , 24h after treatment ( t = 3.35 , P0.05 ) , ( t = 4.56 , P0.05 ) , ( t = 5.41 , P0.05 ) , and the difference was statistically significant .
Compared with the prior therapy , the pulmonary alveolar oxygen partial pressure ratio ( a / A _ 2 ) increased significantly ( P0.05 ) , 12 h and 24 h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time - dependence was presented .
Compared with the traditional mechanical ventilation treatment group , the alveolar oxygen partial pressure ratio ( a / APaO2 ) of the high frequency oscillatory ventilation group was higher , 6h , 12h and 24h after the treatment compared with the traditional mechanical ventilation treatment group ( t = 7.82 , P0.05 ) , ( t = 3.69 , P0.05 ) , ( t = 2.78 , P0.05 ) , and the difference was statistically significant ;
Compared with the traditional mechanical ventilation therapy group , the incidence of pneumothorax in the traditional mechanical ventilation therapy group was significantly higher than that in the traditional mechanical ventilation treatment group ( P0.05 ) .

Conclusion Compared with traditional mechanical ventilation , high - frequency oscillatory ventilation can improve lung ventilation , lung ventilation and oxygenation . It can obviously improve the cure rate , reduce the complications and reduce the mortality rate .
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R722.1

【参考文献】