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。

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 PaO₂ and 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．

目的 为初步评估在无创辅助通气基础上进行雾化肺表面活性物质(AS)治疗呼吸窘迫综合征(RDS)早产儿的安全性及效果,开展了此项临床研究。方法 2019年7月—2020年6月,经监护人知情同意,符合入选标准的RDS早产儿,入院后在经鼻间歇正压通气(NIPPV)基础上,通过振动筛网雾化器系统给予100 mg/kg注射用牛肺表面活性剂,雾化完毕继续无创辅助通气。详细观察及记录患儿在雾化初期的生命体征及血气分析结果,记录在雾化治疗期间不良反应发生情况以及患儿病情转归情况。结果 20例患儿参与研究,1例出生后26天死亡,其余均存活出院。5例在AS治疗后3天内无创辅助通气失败。和雾化前比较,AS治疗后1小时患儿血气分析主要指标均改善,血氧饱和度上升,心率下降(P＜0.05),但血压及呼吸机参数无明显变化(P＞0.05)。在雾化过程中,所有患儿无明显不良反应发生。结论 此项临床研究初步显示AS联合无创辅助通气治疗早产儿RDS是安全可行的,但尚需进一步临床研究评估其效果。

Objective To evaluate the safety and efficacy of non-invasive ventilation with aerosolized surfactant (AS) in the treatment of premature infants with respiratory distress syndrome (RDS). Methods From July 2019 to June 2020, in this unblinded Phase I study, the premature infants with RDS who met the criteria with the informed consent of their guardians were enrolled. They were treated with nasal intermittent positive pressure ventilation (NIPPV) and received one dose (100 mg/kg) of aerosolized surfactant by vibrating mesh system (Aeroneb Solo) after hospitalization. The vital signs, adverse reactions and blood gas during areosolizing were recorded and prognosis of them also recorded in detail. Results Twenty infants were enrolled, nineteen completed the study, one died in 26 days. Five infants still required endotracheal intubation and mechanical ventilation after AS treatment. One hour after AS treatment, infants' oxygen saturation and indicators of pulse oximetry improved (P＜0.05), and heart rate decreased (P＜0.05) , but blood pressure and parameters of ventilator had no change (P＞0.05). Infants all tolerated the aerosol treatment well. No other significant adverse events were identified. Conclusion We have demonstrated the feasibility and safety of AS treatment in preterm infants with RDS receiving non-invasive respiratory support. The treatment was well tolerated by infants and clinical caregivers , but still need further study.

目的 探究肺表面活性物质联合高频振荡通气治疗新生儿呼吸窘迫综合征的有效性及安全性。方法 选取我院新生儿科2016年2月—2018年7月收治的120例呼吸窘迫综合征新生患儿作为研究对象,随机将其分为常规组和试验组,每组各60例。常规组实施肺表面活性物质联合常频振荡通气治疗,试验组采取肺表面活性物质联合高频振荡通气治疗,比较两组治疗前后的肺氧合功能和并发症发生情况。结果 PaO₂、OI、a/A PO₂等指标在治疗前两组差异无统计学意义(P＞0.05),治疗后试验组均要优于常规组,差异有统计学意义(P＜0.05);常规组的并发症发生率为35.0%(21/60),试验组的并发症发生率为18.3%(11/60),试验组低于常规组,差异有统计学意义(P＜0.05)。结论 新生儿呼吸窘迫综合征采用肺表面活性物质联合高频振荡通气治疗效果显著,并发症少,安全性高。