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俯卧位通气在新生儿急性呼吸窘迫综合征治疗中的临床应用

Clinical application of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome

    摘要
  • 摘要:
    目的 观察俯卧位通气在新生儿急性呼吸窘迫综合征（NARDS）治疗中的应用效果。
    方法 回顾性选取46例NARDS患儿作为研究对象，将采用俯卧位通气治疗（俯卧位为主，交替侧卧位）的20例患儿纳入俯卧位组，将采用常规仰卧位通气治疗的26例患儿纳入仰卧位组。比较2组患儿机械通气治疗开始时和机械通气治疗4、24、48、72 h后的动脉血氧分压pa（O2）与吸入氧分数（FiO2）比值（P/F）、氧合指数（OI），观察2组治疗过程中肺表面活性物质（PS）使用次数和机械通气时间、总用氧时间、住院时间，并比较2组患儿治疗过程中相关并发症发生率、病死率等。
    结果 机械通气治疗4、24、48、72 h后，俯卧位组患儿pa（O2）、P/F均高于仰卧位组，OI值低于仰卧位组，差异有统计学意义（P < 0.05）；机械通气治疗72 h后，俯卧位组患儿动脉血二氧化碳分压pa（CO2）低于仰卧位组，差异有统计学意义（P < 0.05）。俯卧位组总用氧时间为（12.53±3.48）d，短于仰卧位组的（15.60±4.46）d，差异有统计学意义（P < 0.05）；2组PS使用次数、机械通气时间和住院时间比较，差异无统计学意义（P>0.05）；2组新生儿持续肺动脉高压发生率、病死率和并发症发生率比较，差异无统计学意义（P>0.05）。
    结论 俯卧位机械通气可有效改善NARDS患儿氧合功能及呼吸功能，缩短用氧时间，且不会增加相关并发症的发生。

     

    Abstract:
    Objective To observe application effect of ventilation in prone position in treatment of neonatal acute respiratory distress syndrome (NARDS).
    Methods A total of 46 neonates with NARDS were retrospectively selected as study objects, among whom 20 cases with ventilation in prone position(mainly using prone position, and alternatively using lateral position) were included in prone position group, while 26 cases ventilated in conventional supine position were selected as supine position group. Arterial partial pressure of oxygenpa(O2) to inhaled oxygen fraction (FiO2) ratio (P/F) and oxygenation index of two groups of neonates at beginning of mechanical ventilation, and 4, 24, 48 and 72 h after mechanical ventilation were compared. The number of using pulmonary surfactant (PS) during treatment, mechanical ventilation time, total oxygen use time and length of hospital stay were observed, the incidence rates of related complications and the mortality during treatment were compared.
    Results The pa(O2) and P/F values of the neonates in the prone position group were higher than those of the supine position group, and the OI value was lower than that of the supine position group at 4, 24, 48 and 72 h after mechanical ventilation (P < 0.05); arterial partial pressure of carbon dioxidepa(CO2) after 72 h of mechanical ventilation was lower than that of the supine position group(P < 0.05). The total oxygen consumption time in the prone position group was shorter than that in the supine position group(12.53±3.48) d versus (15.60±4.46) d, P < 0.05. There were no significant differences in number of pulmonary surfactant usage, mechanical ventilation time and hospital stay (P>0.05). The incidence rates of neonatal persistent pulmonary hypertension, mortality, and complications between the two groups showed no significant differences(P>0.05).
    Conclusion Prone position mechanical ventilation can effectively improve the oxygenation and respiratory function of neonates with NARDS, shorten the time of oxygen use, and does not increase the occurrence of related complications.

     

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