中国实用儿科杂志

中国实用儿科杂志

• 论著 • 上一篇    下一篇

不同机械通气方式治疗胎粪吸入综合征的随机对照研究

夏耀方，刘翠青，魏素芳，张古英   

  1. 河北省儿童医院新生儿科， 河北 石家庄　050031
  • 收稿日期:2008-09-11 修回日期:2008-12-15 出版日期:2009-05-06 发布日期:2010-03-01
  • 通讯作者: 刘翠青

A controlled study on efficacy of different mechanical ventilation mode for neonates with meconium aspiration syndrome.

XIA Yao-fang， LIU Cui-qing， WEI Su-fang， Zhang Gu-ying.   

  1. Neonatology Department of Hebei Province Children Hospital， Shijiazhuang 050031，China
  • Received:2008-09-11 Revised:2008-12-15 Online:2009-05-06 Published:2010-03-01

摘要： 目的　比较不同机械通气方式对胎粪吸入综合征（MAS）患儿的治疗作用及并发症的发生。方法　河北省儿童医院新生儿科重症监护室2006年7月至2008年7月收治的84例氧合指数（OI） ≥ 15的重症胎粪吸入综合征患儿随机分为3组：A组25例患儿采用高频振荡 （HFOV）模式治疗；B组29例患儿采用同步间歇正压联合容量保证 （SIPPV+VG）模式治疗；C组30例采用间歇指令通气（IMV）模式治疗。比较3组治疗前后各时间点OI、动脉/肺泡氧分压比值（a/APO2）的变化，并对3组患儿的氧暴露时间、机械通气时间，以及肺气漏、呼吸机相关性肺炎、Ⅲ度以上颅内出血等并发症的发生率进行比较。结果　A组与B组在机械通气24 h后OI和a/APO2值均与0 h差异有统计学意义（P < 0.05），而C组直到72 h方与0 h时差异有统计学意义（P < 0.05）。A组与B组各时间点相比差异均无统计学意义。A组与B组相比，氧暴露时间和上呼吸机时间均无统计学差异（P > 0.05），但是A组与C组、B组与C组相比在统计学上差异均有统计学意义（P < 0.05）。不仅如此，A组与C组、B组与C组相比，肺气漏与呼吸机相关性肺炎的发生率差异均有统计学意义（P < 0.05）。Ⅲ度以上颅内出血的发生率3组相比差异无统计学意义（P > 0.05）。结论 　HFOV、SIPPV+VG通气模式与IMV比较，可以较快改善MAS的氧合，缩短氧暴露时间和呼吸机使用时间，降低肺气漏和呼吸机相关性肺炎的发生，可作为更有效、更安全的抢救性治疗手段。

关键词: 机械通气, 胎粪吸入综合征, 新生儿, 高频振荡, 容量目标通气

Abstract: Objective　To compare the effect and the differences of complication incidence rate of different mechanical ventilation mode in neonates with meconium aspiration syndrome. Methods　Eligible patients diagnosed with severe MAS admitted consecutively to Neonatal Intensively Care Unit （NICU）of Hebei Children Hospital from July 2006 to July 2008 were included in the study.The patients with an oxygenation index（OI） ≥15 were randomized in a non-blinded manner to receive different mechanical ventilation . They were assigned randomly into Group A（HFOV，n = 25） ，Group B（SIPPV+VG，n = 29） and GroupC（IMV，n = 30）. OI and a/APO2 were monitored at 0 h，24 h，48 h and 72 h after mechanical ventilation . Frequent hemorrhoid and the incidence of interventtricular hemorrhage were recorded. A prospective study was carried on. Informed consent was obtained from parents before enrollment. The protocol and the informed consent forms were approved by the Institutional Review Board .Results　At the beginning of the treatment，no significant differences were detected in OI and a/APO2 among three groups .24 hour later，OI and a/APO2 of group A and group B changed significantly（P＜0.05）. While in group C，the difference was not found until 72 hours. There were no significant differences in OI and a/APO2 between groupA and group B. There were significance difference in statistics between group A and group C as well as group B and group C（P＜0.05）. The incidence rate of lung frequent hemorrhoid and ventilation associated pneumonia in group A and group B were lower than group C . There were no significant differences in the mortality and incidence rate of intracranial hemorrhage among 3 groups （P > 0.05）. Conclusion　Compared with IMV，HFOV and SIPPV+VG can improve oxygenation condition， shorten ventilation time， and decrease the lung frequent hemorrhoid and ventilation-associated pneumonia.It may be conducted as a safe therapy method for MAS.

Key words: high frequency oscillation ventilation （HFOV）, volume targeted ventilation（VG） , meconium aspiration syndrome（MAS）, neonate