目的：评价目标容量控制通气治疗重症新生儿呼吸窘迫综合征（NRDS）的疗效。方法：将2008年6月至2010年1月收治的84例重症NRDS患儿随机分为3组：同步间歇正压加容量保证通气组（SIPPV+VG，31例）、高频振荡通气组（HFOV，23例）、间歇指令通气组（IMV，30例）。观察各组氧合情况、氧疗时间、呼吸机使用时间及并发症发生情况。结果：SIPPV+VG组、HFOV组患儿在上机12 h时氧合明显改善，P/F值、a/APO2与上机前比较差异有统计学意义（P<0.05），而IMV组直至24 h氧合方有改善； SIPPV+VG、HFOV组患儿氧疗时间和呼吸机使用时间均低于IMV组（P<0.05）； SIPPV+VG、HFOV组患儿气漏和呼吸机相关性肺炎（VAP）的发生率均低于IMV组（P<0.05）；HFOV组III级以上颅内出血发生比率高于SIPPV+VG和IMV组。结论：SIPPV+VG和HFOV比IMV能更迅速地改善重症NRDS患儿氧合状况，缩短氧暴露和呼吸机应用时间，减少气漏、VAP的发生。
Abstract
OBJECTIVE: To evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome (RDS). Methods: Eighty-four neonates with severe RDS between June 2008 and January 2010 were randomly assigned to 3 groups according to the ventilation mode: synchronized intermittent positive pressure ventilation plus volume guarantee (SIPPV+VG; n=31), high frequency oscillation ventilation (HFOV; n=23) and intermittent mandatory ventilation (IMV; n=30). The oxygenation status, the durations of oxygen exposure and ventilation and the incidence of complications were observed. Results: The oxygenation status (P/F and a/APO2) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation (P＜0.05). While in the IMV group, the oxygenation status was not improved until 24 hrs after ventilation. The durations of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group (P<0.05). The incidences of air leak syndrome and ventilation-associated pneumonia (VAP) were lower in the SIPPV+VG and the HFOV groups than in the IMV group (P<0.05). The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups (P<0.05). Conclusions: Compared with IMV, SIPPV+VG and HFOV can improve the oxygenation status more quickly, shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS.
关键词
目标容量控制通气 /
同步间歇正压通气 /
高频振荡通气 /
呼吸窘迫综合征 /
新生儿
Key words
Targeted tidal volume ventilation /
Synchronized intermittent positive pressure ventilation /
High frequency oscillation ventilation /
Respiratory distress syndrome /
Neonate
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