高频振荡通气联合布地奈德持续雾化吸入治疗新生儿呼吸窘迫综合征的效果研究

Effect of high-frequency oscillatory ventilation combined with continuous nebulized budesonide in the treatment of neonatal respiratory distress syndrome

摘要:

目的 探讨高频振荡通气（HFOV）联合布地奈德持续雾化吸入治疗新生儿呼吸窘迫综合征（NRDS）的效果。方法 选取2022年1月—2024年9月在温州医科大学附属第二医院收治的84例NRDS患儿，通过随机数字表法分为对照组（HFOV治疗）与观察组（对照组基础上联合布地奈德持续雾化吸入治疗），各42例。对比两组患儿的临床疗效，治疗前后的呼吸力学指标［内源性呼气末正压、气道阻力、呼吸指数（RI）］、血气指标［二氧化碳分压（PaCO₂）、氧分压（PaO₂）、吸氧分数（FiO₂）、血酸碱度（pH）值］、心肌损伤及氧化应激指标［血清肌钙蛋白Ⅰ（cTnⅠ）、肌酸激酶同工酶（CK-MB）、丙二醛（MDA）水平］、通气情况（机械通气时间、氧疗时间、呼吸暂停次数），并比较两组患儿治疗的安全性。结果 观察组临床总有效率高于对照组（P <0.05）。观察组治疗前后内源性呼气末正压差值、气道阻力差值及呼吸指数差值均大于对照组（P <0.05）。观察组PaCO₂下降幅度、PaO₂升高幅度、pH改善幅度及FiO₂下降幅度均大于对照组（P <0.05）。观察组治疗前后cTnⅠ差值、CK-MB差值及MDA差值均大于对照组（P <0.05）。观察组机械通气时间、氧疗时间和呼吸暂停次数均短于/少于对照组（P <0.05）。观察组与对照组支气管肺发育不良率比较，差异有统计学意义（P <0.05）。结论 HFOV联合布地奈德持续雾化吸入治疗NRDS患儿能够有效改善呼吸力学、优化血气状态，降低心肌损伤和氧化应激水平，缩短机械通气和氧疗时间，并降低不良反应发生率，具有临床应用价值。

Abstract:

Objective To investigate the effect of high-frequency oscillatory ventilation (HFOV) combined with continuous nebulized budesonide in the treatment of neonatal respiratory distress syndrome (NRDS).Methods A total of 84 neonates with NRDS were selected from our hospital between January 2022 and September 2024. Using a random number table method, they were randomly divided into the control group (treated with HFOV) and the observation group (treated with HFOV combined with continuous nebulized budesonide), with 42 cases in each group. Clinical efficacy, respiratory mechanics indicators [ (intrinsic positive end-expiratory pressure, airway resistance, respiratory index (RI) ], blood gas indicators [partial pressure of carbon dioxide (PaCO₂), partial pressure of oxygen (PaO₂), fraction of inspired oxygen (FiO₂), blood pH value], myocardial injury and oxidative stress indicators [serum cardiac troponin I (cTnⅠ), creatine kinase isoenzyme (CK-MB), malondialdehyde (MDA) levels], ventilation-related parameters (duration of mechanical ventilation, duration of oxygen therapy, and frequency of apnea episodes), and the safety of the treatment were compared between the groups.Results The overall response rate was significantly higher in the observation group than in the control group (P < 0.05). The differences in intrinsic positive end-expiratory pressure, airway resistance, and RI before and after treatment were significantly greater in the observation group than in the control group (P < 0.05). The decreases in PaCO₂ and FiO₂, as well as the increases in PaO₂ and pH, were significantly greater in the observation group than in the control group (P < 0.05). The differences in cTnI, CK-MB, and MDA levels before and after treatment were significantly greater in the observation group than in the control group (P < 0.05). The duration of mechanical ventilation and the duration of oxygen therapy were shorter, and the number of apnea episodes was lower in the observation group than in the control group (P < 0.05). A comparison of the incidence of bronchopulmonary dysplasia between the observation group and the control group showed a statistically significant difference according to the χ2 test (χ2 = 3.896, P = 0.048).Conclusion HFOV combined with continuous nebulized budesonide effectively improves respiratory mechanics and blood gas status in neonates with NRDS, reduces myocardial injury and oxidative stress levels, shortens the duration of mechanical ventilation and oxygen therapy, and lowers the incidence of adverse events, indicating good clinical application value.