HFOV模式下早期肺表面活性物质干预对呼吸窘迫综合征致重度呼吸衰竭患儿转归的影响

doi:10.20223/j.cnki.1000-8535.2024.11.015

摘要/Abstract

摘要： 目的探究应用高频振荡通气（HFOV）模式下早期肺表面活性物质干预对呼吸窘迫综合征致重度呼吸衰竭患儿转归的影响。方法选取南阳医学高等专科学校第一附属医院2020年6月—2022年12月收治的120例呼吸窘迫综合征致重度呼吸衰竭患儿作为研究对象,按照随机数字表法将其分为对照组与研究组各60例,对照组行常规通气联合早期肺表面活性物质干预,研究组行HFOV联合早期肺表面活性物质干预,对比两组患儿临床症状、血气指标、肺功能指标、患儿转归分析、并发症以及临床疗效。结果研究组患儿症状消失时间为（31.28±10.24）h、呼吸机辅助通气时间为（50.13±15.81）h以及住院天数为（12.47±5.48）d,对照组患儿症状消失时间为（59.91±11.56）h,呼吸机辅助通气时间为（91.17±25.47）h及住院天数为（20.11±9.45）d,研究组低于对照组（P<0.05）;治疗后,研究组患儿PaO₂为（77.89±9.10）mmHg,PaCO₂为（41.09±8.25）mmHg,氧合指数为（432.18±37.81）mmHg,对照组患儿PaO₂为（65.28±8.16）mmHg,PaCO₂为（49.71±8.91）mmHg,氧合指数为（258.64±56.74）mmHg,研究组PaO₂、氧合指数高于对照组,且PaCO₂低于对照组（P<0.05）;治疗后,研究组患儿体重潮气量（TV）为（7.68±2.16）mL/kg,达峰容积比（TPEF/TE）为（34.19±4.06）%,达峰时间比（VPEF/VE）为（33.47±3.42）%,对照组患儿TV为（6.64±2.01）mL/kg,TPEF/TE为（28.66±3.81）%,VPEF/VE为（28.95±3.10）%,研究组高于对照组（P<0.05）;研究组患儿支气管肺发育不良（BPD）为11.66%,对照组为13.33%,两组患儿BPD发生率比较差异无统计学意义（P>0.05）;研究组IVH为3.33%、ROP为5.00,对照组脑室内出血（IVH）为8.33%,早产儿视网膜病（ROP）为11.66%,研究组低于对照组（P<0.05）;研究组患儿并发症发生率为6.66%,对照组患儿并发症发生率为20.00%,研究组低于对照组（P<0.05）;研究组患儿总有效率为96.66%,对照组患儿总有效率为83.33%,研究组高于对照组（P<0.05）。结论 HFOV模式下早期肺表面活性物质干预呼吸窘迫综合征致重度呼吸衰竭患儿效果显著,改善患儿呼吸功能与血气指标,并发症较少。

关键词: 高频振荡通气, 早期肺表面活性物质, 呼吸窘迫综合征致重度呼吸衰竭, 血气指标

Abstract: Objective To investigate the effect of early intervention with pulmonary surfactant under HFOV mode on the outcome of severe respiratory failure in children with respiratory distress syndrome．Methods A total of 120 children with severe respiratory failure caused by respiratory distress syndrome admitted to our hospital from June 2020 to December 2022 were selected as the study subjects．They were randomly divided into a control group and a study group of 60 cases each using a random number table method．The control group received routine ventilation combined with early pulmonary surfactant intervention,while the study group received HFOV combined with early pulmonary surfactant intervention．Symptom disappearance,ventilator-assisted ventilation,hospital stay,blood gas indicators,lung function indicators,analysis of pediatric outcomes,complications,and clinical efficacy were compared between the two groups．Results The time of symptom disappearance was（31.28±10.24）h,the duration of ventilator assisted ventilation was（50.13±15.81）h and the number of days in hospital was（12.47±5.48）d in the study group,while the time of symptom disappearance was（59.91±11.56）h,the duration of ventilator assisted ventilation was（91.17±25.47）h and the number of days in hospital was（20.11±9.45）d in the control group,which were higher than those in the study group（P<0.05）．After treatment,PaO₂ was （77.89±9.10）mmHg,PaCO₂ was （41.09±8.25）mmHg and oxygenation index was （432.18±37.81）mmHg in the study group,while PaO₂ was （65.28±8.16）mmHg,PaCO₂ was （49.71±8.91）mmHg and oxygenation index was （258.64±56.74）mmHg in the control group．The PaO₂and oxygenation index of the study group were higher than those of the control group,and the PaCO₂ was lower than that of the control group（P<0.05）．After treatment,TV in the study group was （7.68±2.16）mL/kg,TPEF/TE was （34.19±4.06）%,VPEF/VE was （33.47±3.42）%,and TV in the control group was （6.64±2.01）mL/kg,TPEF/TE was （28.66±3.81）%,VPEF/VE was （28.95±3.10）%．The study group was higher than the control group（P<0.05）．BPD was 11.66% in the study group and 13.33% in the control group．There was no significant difference in the incidence of BPD between the two groups（P>0.05）．The IVH and ROP of the study group were 3.33% and 5.00 respectively,while those of the control group were 8.33% and 11.66% respectively,which were lower in the study group（P<0.05）．The incidence of complications was 6.66% in the study group and 20.00% in the control group,which was lower in the control group（P<0.05）．The total effective rate was 96.66% in the study group and 83.33% in the control group,which was higher in the control group（P<0.05）．Conclusion sEarly intervention of pulmonary surfactant in children with severe respiratory failure caused by respiratory distress syndrome under HFOV mode has a significant effect,improving respiratory function and blood gas indicators,and reducing complications．

Key words: high-frequency oscillatory ventilation, early pulmonary surfactant, severe respiratory failure caused by respiratory distress syndrome, blood gas indicators

王彬彬, 张晋雷, 杨英阁, 王锦, 孙颖. HFOV模式下早期肺表面活性物质干预对呼吸窘迫综合征致重度呼吸衰竭患儿转归的影响[J]. 广州医药, 2024, 55(11): 1332-1337.

WANG Binbin, ZHANG Jinlei, YANG Yingge, WANG Jin, SUN Ying. The effect of early pulmonary surfactant intervention on the prognosis of severe respiratory failure in children with respiratory distress syndrome under HFOV mode[J]. Guangzhou Medical Journal, 2024, 55(11): 1332-1337.

参考文献

[1] 谢雪霞,刘启洁,田洁.不同剂量肺表面活性物质联合经鼻无创高频通气治疗早产儿呼吸窘迫综合征疗效对比[J].中国计划生育学杂志,2023,31(4):818-821.
[2] 孙艳辉,钟晓云,欧姜凤,等.肺表面活性物质微创给药治疗早产儿呼吸窘迫综合征临床及随访研究[J].中华实用儿科临床杂志,2023,38(3):215-220.
[3] ZOULIKHA M,XIAO Q,BOAFO G F,et al.Pulmonary delivery of siRNA against acute lung injury/acute respiratory distress syndrome[J].Acta Pharm Sin B,2022,12(2):600-620.
[4] REYNOLDS P,BUSTANI P,DARBY C,et al.Less-invasive surfactant administration for neonatal respiratory distress syndrome:A consensus guideline[J].Neonatology,2021,118(5):586-592.
[5] 金宝,周彬,马秀慧,等.低侵入性肺表面活性物质治疗技术联合经鼻间歇正压通气治疗早产儿呼吸窘迫综合征[J].中华急诊医学杂志,2023,32(6):748-754.
[6] 苏婕,石静云,张小妮,等.微创肺表面活性物质应用在早产儿呼吸窘迫综合征中的临床研究[J].中国妇幼健康研究,2023,34(6):48-52.
[7] DARGAVILLE P A,KAMLIN C O F,ORSINI F,et al.Effect of minimally invasive surfactant therapy vs sham treatment on death or bronchopulmonary dysplasia in preterm infants with respiratory distress syndrome:The OPTIMIST-A randomized clinical trial[J].JAMA,2021,326(24):2478-2487.
[8] OLICKER A L,RAFFAY T M,RYAN R M.Neonatal respiratory distress secondary to meconium aspiration syndrome[J].Children(Basel),2021,8(3):246.
[9] 陈秋芳,和俊杰,刘雪杰,等.持续气道正压通气联合微创注入肺表面活性物质对呼吸窘迫综合征新生儿氧合功能及并发症的影响[J].新乡医学院学报,2023,40(8):740-743.
[10] 李小燕,王慧琴,张彬,等.微创肺表面活性物质给药技术在早产儿呼吸窘迫综合征36例中的应用[J].安徽医药,2023,27(3):533-536.
[11] DE LUCA D.Respiratory distress syndrome in preterm neonates in the era of precision medicine:A modern critical care-based approach[J].Pediatr Neonatol,2021,62 Suppl (1):S3-S9.
[12] RAMASWAMY V V,ABIRAMALATHA T,BANDYOPADHYAY T,et al.Surfactant therapy in late preterm and term neonates with respiratory distress syndrome:A systematic review and meta-analysis[J].Arch Dis Child Fetal Neonatal Ed,2022 ,107(4):393-397.
[13] 陈丽,陈信,张阵,等.振动筛网雾化吸入肺表面活性物质和布地奈德治疗早产儿呼吸窘迫综合征临床观察[J].山东医药,2023,63(18):77-80.
[14] 陈历耋,王淑莲,廖奇,等.高频振荡通气联合肺泡表面活性物质治疗新生儿急性呼吸窘迫综合征的临床效果[J].妇儿健康导刊,2023,2(12):53-56.
[15] FEI Q,BENTLEY I,GHADIALI S N,et al.Pulmonary drug delivery for acute respiratory distress syndrome[J].Pulm Pharmacol Ther,2023(79):102196.
[16] GUPTA B K,SAHA A K,MUKHERJEE S,et al.Minimally invasive surfactant therapy versus InSurE in preterm neonates of 28 to 34 weeks with respiratory distress syndrome on non-invasive positive pressure ventilation-a randomized controlled trial[J].Eur J Pediatr,2020 ,179(8):1287-1293.
[17] 常晶. 高频振荡通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的效果[J].临床医学,2023,43(7):35-37.
[18] 陈艳江,徐建梅,师麟尧.高频振荡通气模式下肺表面活性物质最佳使用时间选择及对新生儿重度呼吸衰竭转归影响的差异研究[J].海军医学杂志,2023,44(2):182-185.
[19] 范振敏. 高频振荡通气联合肺表面活性物质治疗新生儿急性呼吸窘迫综合征的临床观察[J].实用中西医结合临床,2021,21(19):90-91.
[20] 潘红,刘世英.高频振荡通气结合肺泡表面活性物质治疗新生儿呼吸窘迫综合征的效果分析[J].基层医学论坛,2020,24(23):3282-3283.
[21] 周菲菲,王国胜,董海丽.氨溴索静脉用药联合不同通气方式治疗新生儿呼吸窘迫综合征的疗效评价[J].广州医药,2023,54(1):76-79.
[22] 刘颖,段顺艳,杜岚岚,等.雾化肺表面活性物质联合无创辅助通气治疗新生儿呼吸窘迫综合征[J].广州医药,2022,53(2):1-6.
[23] YEHYA N,SMITH L,THOMAS N J,et al.Second Pediatric Acute Lung Injury Consensus Conference(PALICC-2)of the Pediatric Acute Lung Injury and Sepsis Investigators(PALISI)Network.Definition,Incidence,and Epidemiology of Pediatric Acute Respiratory Distress Syndrome:From the Second Pediatric Acute Lung Injury Consensus Conference[J].Pediatr Crit Care Med,2023,24(12 Suppl 2):S87-S98.
[24] ANGUS D C,SEYMOUR C W,BIBBINS-DOMINGO K.Caring for patients with acute respiratory distress syndrome:Summary of the 2023 ESICM Practice Guidelines[J].JAMA,2023,330(4):368-371.
[25] 左浩. 跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征的临床应用效果[J].广州医药,2021,52(6):59-62.