高频振荡通气对新生儿呼吸窘迫综合征患儿心功能的影响
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摘要
目的探究高频振荡通气(high frequency oscillation ventilation,HFOV)对新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)患儿心功能的影响。方法回顾性分析2016年3月至2017年12月本院经HFOV治疗(观察组,42例)和经常频机械通气(conventional mechanical ventilation,CMV)治疗(对照组,42例)的NRDS患儿的临床资料,比较两组患儿病情转归、并发症发生率及存活患儿治疗时间(机械通气时间、吸氧时间、住院天数)的差异以及两组存活患儿治疗前及治疗48小时后血气分析指标[p H、动脉血氧分压(arterial partial pressure of oxygen,Pa O2)、动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,Pa CO2)、氧合指数(oxygenation index,OI)]、治疗前及治疗7天后左心功能指标[左心室射血分数(left ventricle ejection fraction,LVEF)、心输出量(cardiac output,CO)、二尖瓣口血流舒张早期峰值流速/舒张晚期峰值流速(E/A比值)、左心室Tei指数(LV-Tei)]差异。结果两组患儿死亡率和并发症发生率比较均无显著差异(P_均> 0.05)。观察组存活患儿机械通气时间、吸氧时间、住院天数均显著短于对照组存活患儿(P_均<0.05)。治疗48小时后,两组存活患儿p H、Pa O2均显著高于本组治疗前(P_均<0.05),Pa CO2、OI均显著低于本组治疗前(P_均<0.05),且观察组存活患儿上述指标变化幅度均显著大于同期对照组(P_均<0.05)。治疗7天后,两组存活患儿LVEF、CO、E/A均显著高于本组治疗前(P_均<0.05),LV-Tei显著低于本组治疗前(P <0.05),且观察组存活患儿上述指标的变化幅度均显著大于同期对照组(P_均<0.05)。结论 HFOV能显著改善NRDS患儿的心功能,临床应用价值较高。
Objective To explore the effects of high frequency oscillation ventilation(HFOV) on cardio function in children with neonatal respiratory distress syndrome(NRDS).Method The clinical data of children with NRDS who were treated with HFOV(observation group,42 cases) and conventional mechanical ventilation(CMV)(control group,42 cases) from March 2016 to December 2017 were retrospectively analyzed.The difference of prognosis,incidence of complications and treatment time(mechanical ventilation time,oxygen inhalation time,hospital day) and the blood gas analysis indexes [p H,arterial partial pressure of oxygen(Pa O2),arterial partial pressure of carbon dioxide(Pa CO2),oxygenation index(OI)] of survival children before treatment and 48 hours after treatment,and left heart function indexes [left ventricular ejection fraction(LVEF),cardiac output(CO),mitral valve early diastolic peak/late diastolic peak(E/A ratio),left ventricular Tei index(LV-Tei)] before treatment and 7 days after treatment were compared between the two groups.Result There were no significant differences in the mortality rate and complication rate between the two groups(P_(all)>0.05).The mechanical ventilation time,oxygen inhalation time and hospital day of survival children in observation group were lower than those of survival children in control group(P_(all)<0.05).48 hours after treatment,pH and PaO2 of survival children in the two groups were higher than those before treatment(P_(all)<0.05),while PaCO2 and OI were lower than those before treatment(P_(all)<0.05),and the changes in observation group were greater than those in control group(P_(all)<0.05).7 days after treatment,the LVEF,CO,E/A ratio in the two groups were higher than those before treatment(P_(all)<0.05),while the LV-Tei was lower than that before treatment(P<0.05),and the changes in observation group were greater than those in control group(P_(all)<0.05).Conclusion HFOV can significantly improve cardiac function in children with NRDS,and has high clinical value.
Objective To explore the effects of high frequency oscillation ventilation(HFOV) on cardio function in children with neonatal respiratory distress syndrome(NRDS).Method The clinical data of children with NRDS who were treated with HFOV(observation group,42 cases) and conventional mechanical ventilation(CMV)(control group,42 cases) from March 2016 to December 2017 were retrospectively analyzed.The difference of prognosis,incidence of complications and treatment time(mechanical ventilation time,oxygen inhalation time,hospital day) and the blood gas analysis indexes [p H,arterial partial pressure of oxygen(Pa O2),arterial partial pressure of carbon dioxide(Pa CO2),oxygenation index(OI)] of survival children before treatment and 48 hours after treatment,and left heart function indexes [left ventricular ejection fraction(LVEF),cardiac output(CO),mitral valve early diastolic peak/late diastolic peak(E/A ratio),left ventricular Tei index(LV-Tei)] before treatment and 7 days after treatment were compared between the two groups.Result There were no significant differences in the mortality rate and complication rate between the two groups(P_(all)>0.05).The mechanical ventilation time,oxygen inhalation time and hospital day of survival children in observation group were lower than those of survival children in control group(P_(all)<0.05).48 hours after treatment,pH and PaO2 of survival children in the two groups were higher than those before treatment(P_(all)<0.05),while PaCO2 and OI were lower than those before treatment(P_(all)<0.05),and the changes in observation group were greater than those in control group(P_(all)<0.05).7 days after treatment,the LVEF,CO,E/A ratio in the two groups were higher than those before treatment(P_(all)<0.05),while the LV-Tei was lower than that before treatment(P<0.05),and the changes in observation group were greater than those in control group(P_(all)<0.05).Conclusion HFOV can significantly improve cardiac function in children with NRDS,and has high clinical value.
引文
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[21]陶海峰,陶敏,蔡娜,等.经鼻同步间歇指令通气在重度呼吸窘迫综合征早产儿撤机后的应用[J].中国当代儿科杂志,2016,18(1):1-5.
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[2]张靖,张焕新,王景.不同剂量牛肺表面活性剂联合经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床观察[J].中国药房,2016,27(35):4985-4987.
[3]刘迎庆.高频振荡通气治疗新生儿呼吸窘迫综合征30例疗效及安全性观察[J].中国实用儿科杂志,2016,31(6):466-468.
[4]孔凡玲,胡绍举,刘宽,等.新生儿窒息后对心肌损伤标志物的影响以及磷酸肌酸钠的干预效果分析[J].广东医学,2018,39(9):1398-1401.
[5]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011.
[6]Sweet DG,Carnielli V,Greisen G,et al.European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2010 update[J].Neonatology,2010,97(4):402-417.
[7]Zhang C,Zhu X.Clinical effects of pulmonary surfactant in combination with nasal continuous positive airway pressure therapy on neonatal respiratory distress syndrome[J].Pak JMed Sci,2017,33(3):621-625.
[8]Gliske SV,Irwin ZT,Davis KA,et al.Universal automated high frequency oscillation detector for real-time,long term EEG[J].Clin Neurophysiol,2016,127(2):1057-1066.
[9]Doorduin J,Sinderby CA,Beck J,et al.Assisted Ventilation in Patients with Acute Respiratory Distress Syndrome:Lungdistending Pressure and Patient-Ventilator Interaction[J].Anesthesiology,2016,123(1):181-190.
[10]Guragain H,Cimbalnik J,Stead M,et al.Spatial variation in high-frequency oscillation rates and amplitudes in intracranial EEG[J].Neurology,2018,90(8):639-646.
[11]Morgan S,Hornik CP,Patel N,et al.Continuous High-Frequency Oscillation Therapy in Invasively Ventilated Pediatric Subjects in the Critical Care Setting[J].Respir Care,2016,61(11):1451-1455.
[12]Fedele T,Sch?nenberger C,Curio G,et al.Intraoperative subdural low-noise EEG recording of the high frequency oscillation in the somatosensory evoked potential[J].Clin Neurophysiol,2017,128(10):1851-1857.
[13]Chuang ML,Chou YL,Lee CY,et al.Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation:A randomized controlled study[J].Medicine(Baltimore),2017,96(9):5912-5919.
[14]程燕雯,杜辛歌,王迎难,等.沙丁胺醇联合布地奈德对重症肺炎合并呼吸窘迫综合征患者心功能及血气分析的影响[J].疑难病杂志,2016,15(4):362-365.
[15]Kobayashi Y,Tonino PA,De Bruyne B,et al.The impact of left ventricular ejection fraction on fractional flow reserve:Insights from the FAME(Fractional flow reserve versus Angiography for Multivessel Evaluation)trial[J].Int J Cardiol,2016,204:206-210.
[16]詹银周,张兴安,郭春明,等.PICCO监测心率变异性及心输出量与Narcotrend麻醉深度监测对比研究[J].实用医学杂志,2018,34(5):791-795,799.
[17]魏琳萍.芪苈强心胶囊联合曲美他嗪片治疗冠心病舒张性心力衰竭的疗效研究[J].中华全科医学,2016,14(12):2142-2143.
[18]Nakamura K,Morita T,Osuga T,et al.Prognostic Value of Right Ventricular Tei Index in Dogs with Myxomatous Mitral Valvular Heart Disease[J].J Vet Intern Med,2016,30(1):69-75.
[19]周英,顾美群,李明霞.常频与高频呼吸机治疗早产儿呼吸窘迫综合征疗效对比[J].中华新生儿科杂志,2016,31(1):19-23.
[20]符梅竹,郭少丽,王丹.鼻塞式同步间歇指令通气联合肺表面活性物质治疗新生儿肺透明膜病的临床疗效[J].山东医药,2017,57(33):93-95.
[21]陶海峰,陶敏,蔡娜,等.经鼻同步间歇指令通气在重度呼吸窘迫综合征早产儿撤机后的应用[J].中国当代儿科杂志,2016,18(1):1-5.
[22]陈丽,李娟.重症RDS患儿用HFOV治疗的临床效果分析[J].临床肺科杂志,2017,22(6):1033-1036.