三种不同通气方式在新生儿呼吸窘迫综合征治疗中的应用价值研究

区晓毅 廖继研 李顺好 陈赞钢

【摘要】 目的：觀察本院特色加热湿化高流量通气在新生儿呼吸窘迫综合征（RDS）辅助治疗中的应用效果，探讨该病的最佳治疗方式。方法：选择本院2016年7月-2017年12月收治的150例呼吸窘迫综合征新生儿作为研究对象，按照随机数字表法将患儿分为A、B、C组，每组50例，均在给予肺泡表面活性物质治疗后再给予三种不同的通气方式治疗，其中A组使用气管插管上有创呼吸机治疗；B组使用无创呼吸机联合鼻塞通气治疗；C组使用本院特色的加热湿化高流量通气治疗。比较三组治疗前后的相关血气指标以及住院时间、氧疗时间、辅助通气时间、临床效果、并发症发生率以及死亡率。结果：治疗24 h，三组SpO2、PaO2均较治疗前明显升高，PaCO2均较治疗前明显降低（P<0.05）；治疗24 h，B、C组的PaO2均高于A组，C组的SpO2高于A组，差异均有统计学意义（P<0.05）。三组的辅助通气时间、氧疗时间、住院时间比较，差异均有统计学意义（P<0.05）；B、C组的辅助通气时间、氧疗时间、住院时间，均短于A组，差异均有统计学意义（P<0.05）；C组的住院时间短于B组，差异有统计学意义（P<0.05）。A组的总有效率为96.00%、B组为98.00%、C组为98.00%，三组比较差异无统计学意义（字2=0.514，P=0.773）。C组的VAP和其他并发症发生率分别为14.00%和10.00%，均明显低于A组的42.00%、50.00%和B组的36.00%、26.00%（P<0.05）。三组死亡率比较，差异无统计学意义（P>0.05）。结论：加热湿化高流量通气是RDS患儿辅助治疗的有效方法，对技术的要求比较低，可以在其他医院推广使用。

【关键词】 加热湿化高流量通气； 新生儿； 呼吸窘迫综合征； 辅助治疗

【Abstract】 Objective：To observe the application effect of the characteristic heating and humidification of our hospital in the adjuvant therapy of neonatal respiratory distress syndrome（RDS），and to explore the best treatment modality of the disease.Method：150 cases of neonatal respiratory distress syndrome from July 2016 to December 2017 were analyzed as the research objects，the children were divided into group A，B and C according to the random number table，50 cases in each group.All were given alveolar surfactant treatment followed by three different ventilation methods，group A was treated with invasive ventilator on tracheal intubation，group Bwas treated with non-invasive ventilator combined with nasal congestion ventilation，group C was treated with the hospitals special heat humidification and high flow ventilation.The related blood gas indexes before and after treatment，the clinical effect of time of oxygen therapy in hospital and time of ventilation in the three groups，the incidence of complications and mortality among the three groups were compared.Result：After 24 h treatment compared with before treatment，SpO2，PaO2 were significantly increased in all three groups，and PaCO2 were significantly reduced in all three groups（P<0.05），the PaO2 in group B and group C were higher than that in group A，and SpO2 in group C was higher than that in group A，the differences were statistically significant（P<0.05）.The time of ventilation，oxygen therapy and hospital stay of the three groups were compared，the differences were statistically significant（P<0.05）；the auxiliary ventilation time，oxygen therapy time，hospitalization time in group B and C were shorter than those in group A，the differences were statistically significant（P<0.05）；the hospitalization time in group C was shorter than that in group B，the difference was statistically significant（P<0.05）.The total effective rate of group A was 96.00%，group B was 98.00%，group C was 98.00%，there was no significant difference among the three groups（字2=0.514，P=0.773）.VAP and other complications were 14.00% and 10.00% in group C，significantly lower than 42.00%，50.00% in group A and 36.00%，26.00% in group B（P<0.05）.There was no significant difference in mortality among the three groups（P>0.05）.Conclusion：Heating and humidifying high flow ventilation is an effective method of adjuvant therapy for children with RDS，and the requirement of technology is relatively low，so it can be popularized and used in other hospitals.

【Key words】 Heating and humidifying high flow ventilation； Newborn； Respiratory distress syndrome；Adjuvant therapy First-authors address：Yingde City Maternal and Child Health Care Family Planning Service Center，Yingde 513000，China

doi：10.3969/j.issn.1674-4985.2018.32.001

呼吸窘迫综合征（respiratory distress syndrome，RDS）具有高死亡率和高发病率，其治疗比较棘手，一直是新生儿科的难题[1-3]。本研究采用加热湿化高流量通气治疗新生儿RDS，并与气管插管上有创呼吸机和无创呼吸机联合鼻塞通气两种方法进行比较，目的是用最安全有效的方式治疗呼吸窘迫患儿，现将研究结果报告如下。

1 资料与方法

1.1 一般资料 选择2016年7月-2017年12月本院收治的150例呼吸窘迫综合征新生儿作为研究对象，纳入标准：新生儿有RDS症状体征，X线片检查为Ⅲ、Ⅳ级，参考《实用新生儿学》中RDS诊断标准[4]，需要进行呼吸机辅助呼吸者；……