容量保证的高频振荡通气对呼吸窘迫综合征早产儿的疗效分析及对大脑中动脉脑血流的影响

doi:10.7499/j.issn.1008-8830.2409030

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摘要目的探讨容量保证的高频振荡通气（volume-guaranteed high-frequency oscillatory ventilation，HFOV-VG）对呼吸窘迫综合征（respiratory distress syndrome, RDS）早产儿的治疗效果及对大脑中动脉血流的影响。方法前瞻性选取2020年3月—2023年12月于秦皇岛市妇幼保健院新生儿科收治的RDS早产儿120例为研究对象。依据通气模式不同分为常频机械通气（conventional mechanical ventilation, CMV）组（60例）和HFOV-VG组（60例），比较2组基线资料、MCA脑血流动力学参数、并发症及转归情况。结果与CMV组比较，HFOV-VG组的机械通气时长、住院时长缩短，总有效率升高（P<0.05）。HFOV-VG组收缩期峰值流速、舒张末期流速和平均流速均优于CMV组（P<0.05）。与CMV组比较，HFOV-VG组早产儿的28 d病死率、支气管肺发育不良发生率和脑室内出血发生率均降低（P<0.05）。结论 HFOV-VG可有效改善脑血流灌注和降低脑血管阻力，缩短机械通气时长、住院时长，提升总体疗效，HFOV-VG在降低RDS早产儿28 d内死亡风险、支气管肺发育不良和脑室内出血发生风险方面均有显著优势。

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	王月怡
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关键词 ：呼吸窘迫综合征, 容量保证的高频振荡通气, 脑血流, 疗效, 早产儿

Abstract：Objective To investigate the efficacy of volume-guaranteed high-frequency oscillatory ventilation (HFOV-VG) in preterm infants with respiratory distress syndrome (RDS) and its impact on blood flow in the middle cerebral artery (MCA). Methods A prospective study was conducted on 120 preterm infants with RDS who were admitted to the Department of Neonatology at Qinhuangdao Maternal and Child Health Hospital from March 2020 to December 2023. According to the mode of ventilation, the infants were divided into two groups: a conventional mechanical ventilation (CMV) group (60 infants) and an HFOV-VG group (60 infants). The two groups were compared in terms of baseline data, MCA hemodynamic parameters, complications, and outcomes. Results Compared with the CMV group, the HFOV-VG group had significantly shorter durations of mechanical ventilation and hospital stay and a significantly higher overall response rate (P<0.05). The HFOV-VG group demonstrated significantly better peak systolic velocity, end-diastolic velocity, and mean flow velocity (P<0.05). The HFOV-VG group also exhibited significantly lower 28-day mortality rates and lower incidence rates of bronchopulmonary dysplasia and intraventricular hemorrhage than the CMV group (P<0.05). Conclusions HFOV-VG can effectively improve cerebral blood perfusion, reduce cerebrovascular resistance, shorten the durations of mechanical ventilation and hospital stay, and enhance overall treatment efficacy. It has significant advantages in reducing the risk of 28-day mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage in preterm infants with RDS.

Key words： Respiratory distress syndrome Volume-guaranteed high-frequency oscillatory ventilation Cerebral blood flow Efficacy Preterm infant

收稿日期: 2024-09-04

通讯作者: 朱洪斌，男，副主任医师。Email：hongbinzhu2007@163.com。 E-mail: hongbinzhu2007@163.com

作者简介: 王月怡，女，大学本科，副主任医师；

引用本文:

王月怡,魏雪旭,尹海伟等. 容量保证的高频振荡通气对呼吸窘迫综合征早产儿的疗效分析及对大脑中动脉脑血流的影响[J]. 中国当代儿科杂志, 2025, 27(3): 286-292.

WANG Yue-Yi,WEI Xue-Xu,YIN Hai-Wei et al. Efficacy of volume-guaranteed high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome and its impact on cerebral blood flow in the middle cerebral artery[J]. CJCP, 2025, 27(3): 286-292.

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http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2409030 或 http://www.zgddek.com/CN/Y2025/V27/I3/286

	Dargaville PA, Kamlin COF, Orsini F, et al. Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome: the OPTIMIST-A randomized clinical trial[J]. JAMA, 2021, 326(24): 2478-2487. PMID: 34902013. PMCID: PMC8715350. DOI: 10.1001/jama.2021.21892.
	Bos LDJ, Ware LB. Acute respiratory distress syndrome: causes, pathophysiology, and phenotypes[J]. Lancet, 2022, 400(10358): 1145-1156. PMID: 36070787. DOI: 10.1016/S0140-6736(22)01485-4.
	Pelosi P, Ball L, Barbas CSV, et al. Personalized mechanical ventilation in acute respiratory distress syndrome[J]. Crit Care, 2021, 25(1): 250. PMID: 34271958. PMCID: PMC8284184. DOI: 10.1186/s13054-021-03686-3.
	Reynolds P, Bustani P, Darby C, et al. Less-invasive surfactant administration for neonatal respiratory distress syndrome: a consensus guideline[J]. Neonatology, 2021, 118(5): 586-592. PMID: 34515188. DOI: 10.1159/000518396.
	Bitker L, Talmor D, Richard JC. Imaging the acute respiratory distress syndrome: past, present and future[J]. Intensive Care Med, 2022, 48(8): 995-1008. PMID: 35833958. PMCID: PMC9281340. DOI: 10.1007/s00134-022-06809-8.
	Bittner E, Sheridan R. Acute respiratory distress syndrome, mechanical ventilation, and inhalation injury in burn patients[J]. Surg Clin North Am, 2023, 103(3): 439-451. PMID: 37149380. PMCID: PMC10028407. DOI: 10.1016/j.suc.2023.01.006.
	Deming RS, Mazzola E, MacDonald J, et al. Care intensity and palliative care in chronically critically ill infants[J]. J Pain Symptom Manage, 2022, 64(5): 486-494. PMID: 35840043. DOI: 10.1016/j.jpainsymman.2022.07.002.
	Dumpa V, Avulakunta I, Bhandari V. Respiratory management in the premature neonate[J]. Expert Rev Respir Med, 2023, 17(2): 155-170. PMID: 36803028. DOI: 10.1080/17476348.2023.2183843.
	Ramaswamy VV, Abiramalatha T, Bandyopadhyay T, et al. Surfactant therapy in late preterm and term neonates with respiratory distress syndrome: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2022, 107(4): 393-397. PMID: 34686533. DOI: 10.1136/archdischild-2021-322890.
	Yu X, Tan Q, Li J, et al. Elective high frequency oscillatory ventilation versus conventional mechanical ventilation on the chronic lung disease or death in preterm infants administered surfactant: a systematic review and meta-analysis[J]. J Perinatol, 2025, 45(1):77-84. PMID: 39623024. DOI: 10.1038/s41372-024-02185-x.
	Solís-García G, Ramos-Navarro C, González-Pacheco N, et al. Lung protection strategy with high-frequency oscillatory ventilation improves respiratory outcomes at two years in preterm respiratory distress syndrome: a before and after, quality improvement study[J]. J Matern Fetal Neonatal Med, 2022, 35(26): 10698-10705. PMID: 36521851. DOI: 10.1080/14767058.2022.2155040.
	Silveira RC, Panceri C, Mun?z NP, et al. Less invasive surfactant administration versus intubation-surfactant-extubation in the treatment of neonatal respiratory distress syndrome: a systematic review and meta-analyses[J]. J Pediatr (Rio J), 2024, 100(1): 8-24. PMID: 37353207. PMCID: PMC10751720. DOI: 10.1016/j.jped.2023.05.008.
	Miralizadeh A, Peyman A, Jamali Soltani N, et al. Comparison of the effect of foot and palm reflexology massage on respiratory distress syndrome in premature infants under noninvasive ventilation[J]. Complement Med Res, 2022, 29(2): 100-108. PMID: 34818220. DOI: 10.1159/000517982.
	Lin HZ, Lin WH, Lin SH, et al. Application of high-frequency oscillation ventilation combined with volume guarantee in preterm infants with acute hypoxic respiratory failure after patent ductus arteriosus ligation[J]. Heart Surg Forum, 2022, 25(5): E709-E714. PMID: 36317914. DOI: 10.1532/hsf.4825.
	Rodríguez Sánchez de la Blanca A, Sánchez Luna M, González Pacheco N, et al. New indicators for optimal lung recruitment during high frequency oscillator ventilation[J]. Pediatr Pulmonol, 2020, 55(12): 3525-3531. PMID: 32965770. DOI: 10.1002/ppul.25084.
	Bhogal J, Solev?g AL, O'Reilly M, et al. Hemodynamic effects of high frequency oscillatory ventilation with volume guarantee in a piglet model of respiratory distress syndrome[J]. PLoS One, 2021, 16(2): e0246996. PMID: 33592023. PMCID: PMC7886162. DOI: 10.1371/journal.pone.0246996.