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目的对比高频振荡通气(HFOV)和常规机械通气(CMV)治疗气胸新生儿的临床效果以及对血气指标与肺功能的影响。方法回顾性分析2012年10月-2016年6月于该院新生儿科就诊的气胸新生儿76例,根据通气方法分为HFOV组(39例)和CMV组(37例),对比两组患儿的机械通气时间、高浓度给氧时间、给氧总时间及住院时间,对比两组患儿支气管发育不良、颅内出血和死亡的发生率,对比两组患儿的肺功能指标和随访结果。结果HFOV组的胸腔闭式引流时间、机械通气时间和吸高浓度氧时间均显著少于CMV组(P<0.05),两组总用氧时间、住院时间、支气管肺发育不良率、颅内出血率和死亡率对比,差异均无统计学意义(P>0.05);治疗24 h后,HFOV组p H值、血氧分压(Pa O_2)和动脉血氧分压/肺泡氧分压比值(Pa O_2/PAO_2)显著高于CMV组,差异有统计学意义(P<0.05),且HFOV组的二氧化碳分压(Pa CO_2)、氧合指数(OI)和呼吸指数(RI)显著低于CMV组(P<0.05);治疗6个月后两组患儿的呼吸频率、潮气量、达峰时间比、达峰容积比比较,差异无统计学意义(P>0.05);两组新生儿出现呼吸道感染和使用支气管扩张剂的比例比较,差异无统计学意义(P>0.05)。结论HFOV能更有效地改善气胸新生儿血气指标以及减少胸腔闭式引流时间、机械通气时间和吸高浓度氧时间,对肺发育及功能影响较小。
Objective To compare the clinical effects of high frequency oscillatory ventilation (HFOV) and conventional mechanical ventilation (CMV) on neonates with pneumothorax and their effects on blood gas indexes and pulmonary function. Methods A retrospective analysis of 76 neonates with pneumothorax was performed in neonates from October 2012 to June 2016. The patients were divided into HFOV group (39 cases) and CMV group (37 cases) according to ventilation method. The time of mechanical ventilation, the time of high oxygen supply, the total time of oxygen supply and the length of hospital stay were compared. The incidence of bronchial dysplasia, intracranial hemorrhage and death were compared between the two groups. The pulmonary function indexes and follow-up results were compared between the two groups. Results In the HFOV group, the time of thoracic closed drainage, the time of mechanical ventilation and the time of high oxygen concentration were significantly less than those of CMV group (P <0.05). The total oxygen consumption time, length of hospital stay, bronchopulmonary dysplasia rate, intracranial hemorrhage rate (P> 0.05). After treatment for 24 h, the values of p H, Pa O 2 and Pa / Pa in the HFOV group were significantly higher than those in the control group O_2 / PAO_2) was significantly higher than that of CMV group (P <0.05). The PaCO_2, OI and RI of HFOV group were significantly lower than those of CMV group (P <0.05). There was no significant difference in respiratory rate, tidal volume, peak time and peak volume ratio between the two groups after 6 months of treatment (P> 0.05) There were no significant differences in the rates of bronchodilator infection and bronchodilator use (P> 0.05). Conclusion HFOV can effectively improve the blood gas index of neonates with pneumothorax and reduce the time of closed thoracic drainage, mechanical ventilation time and high concentration of oxygen, which has little effect on lung development and function.