两种无创通气模式治疗新生儿胎粪吸入综合征的疗效分析

Efficacy of two modes of noninvasive ventilation in the treatment of neonatal meconium aspiration syndrome

摘要:

目的?探讨无创高频通气与无创经鼻间歇通气治疗新生儿胎粪吸入综合征的疗效评价。方法?选 取2017年12月—2019年6月徐州医科大学附属儿童医院收治的96例新生儿胎粪吸入综合征患儿，将患儿依照不同治疗方式分为无创高频通气组和无创经鼻间歇通气组。无创高频通气组给予清除呼吸道、抗感染、改善循环、心电监护等常规治疗，并实施无创高频通气治疗。无创经鼻间歇通气组在常规治疗的基础上给予无创经鼻间歇通气治疗。比较两组患儿呼吸机使用时间、氧疗时间和住院时间，两组治疗后2?h、12?h、24?h及48?h患儿血气分析指标和氧合指数（PaO2/FiO2），两组治疗后72?h患儿临床疗效及治疗期间并发症发生率。 结果?无创高频通气组呼吸机使用时间、氧疗时间和住院时间较无创经鼻间歇通气组低（P?<0.05）。两组患儿治疗后2?h、12?h、24?h及48?h的PaO2、PaCO2、FiO2和PaO2/FiO2在不同时间、变化趋势上有差异（P?>0.05），组间比较无差异。两组患儿治疗后72?h临床疗效及总有效率比较，差异无统计学意义（P?>0.05）。两组患儿治疗期间并发症发生率比较，差异无统计学意义（P?>0.05）。结论?无创高频通气和无创经鼻间歇通气均能明显改善血气分析指标和PaO2/FiO2，有效率和并发症发生率均相近，但无创高频通气治疗能够缩短呼吸机使用时间、氧疗时间及住院时间。

Abstract:

Objective To evaluate the efficacy of the non-invasive high-frequency oscillatory ventilation (NHOV) and nasal intermittent positive pressure ventilation (NIPPV) in the treatment of neonatal meconium aspiration syndrome (MAS).?Methods?The data of 96 neonates with MAS admitted to Xuzhou Children’s Hospital from December 2017 to June 2019 were reviewed. According to the ventilation modes, the subjects were divided into group A (50 cases) and group B (46 cases). Group A was given conventional treatments including clearing the respiratory tract, anti-infection, improving circulation and electrocardiogram monitoring as well as implementing NHOV. Group B was given NIPPV on the basis of conventional treatment. The duration of ventilation, oxygen therapy and hospital stay, parameters for blood gas analysis and oxygenation index (PaO2/FiO2) at 2 h, 12 h, 24 h, 48 h after treatment, clinical efficacy at 72 h after treatment and the incidence of complications during the treatment were compared in both groups.?Results?The duration of ventilation, oxygen therapy and hospital stay in group A was all shorter than that in the group B (P < 0.05). The parameters for blood gas analysis and oxygenation index at 2 h, 12 h, 24 h and 48 h after treatment in group A and group B were compared, and it was found that PaO2, PaCO2, FiO2 and PaO2/FiO2 were different at different time points (P < 0.05). However, there was no significant difference in PaO2, PaCO2, FiO2 and PaO2/FiO2 between group A and group B (P > 0.05). Besides, there were significant differences in the change trend of PaO2, PaCO2, FiO2 and PaO2/FiO2 between group A and group B (P? 0.05). In addition, there was no significant difference in the incidence of complications between the two groups (P > 0.05).?Conclusions?NHOV and NIPPV can significantly improve the parameters for blood gas analysis and oxygenation index in the treatment of neonatal MAS. The effective rates and incidence of complications are similar between the two modes of noninvasive ventilation, but NHOV can shorten the duration of ventilation, oxygen therapy and hospital stay.