CAJ | 학술논문

目的：观察不同通气模式联合肺表面活性物质（PS）、沐舒坦治疗早产儿肺透明膜病的疗效。方法收集2013年1月至2015年2月徐州市中心医院新生儿重症监护病房（NICU）收治76例患肺透明膜病（HMD）（Ⅲ～Ⅳ级）机械通气早产儿，采用随机数字表法将患儿分为高频震荡通气（HFOV）组40例和常规机械通气（CMV）组36例。两组在上机初即开始应用PS，HFOV组同时每日静脉给予沐舒坦30 mg/kg。观察两组早产儿上机前后血气指标、相关呼吸功能指标变化以及并发症发生率等。结果 HFOV 组上机1 h、12 h、24 h 评估 PaO2、PaO2/FiO2、氧合指数（OI=100×MAP×FiO2/PaO2）、动脉/肺泡氧分压比值（a/APO2）=PaO2/（713×FiO2－PaCO2/0.8）与CMV组比较有明显改善，差异均有统计学意义（P＜0.05）；HFOV组与CMV组死亡例数、上机时间、气胸、支气管肺发育不良（BPD）、早产儿视网膜病（ROP）例数、早产儿脑室内出血（IVH）及脑室周围白质软化（PVL）例数比较，差异均无统计学意义（P＞0.05）。结论联合应用HFOV、PS、沐舒坦治疗早产儿肺透明膜病可以改善其动脉血气指标和呼吸功能指标，改善其氧合，有一定的推广应用价值。
목적：관찰불동통기모식연합폐표면활성물질（PS）、목서탄치료조산인폐투명막병적료효。방법수집2013년1월지2015년2월서주시중심의원신생인중증감호병방（NICU）수치76례환폐투명막병（HMD）（Ⅲ～Ⅳ급）궤계통기조산인，채용수궤수자표법장환인분위고빈진탕통기（HFOV）조40례화상규궤계통기（CMV）조36례。량조재상궤초즉개시응용PS，HFOV조동시매일정맥급여목서탄30 mg/kg。관찰량조조산인상궤전후혈기지표、상관호흡공능지표변화이급병발증발생솔등。결과 HFOV 조상궤1 h、12 h、24 h 평고 PaO2、PaO2/FiO2、양합지수（OI=100×MAP×FiO2/PaO2）、동맥/폐포양분압비치（a/APO2）=PaO2/（713×FiO2－PaCO2/0.8）여CMV조비교유명현개선，차이균유통계학의의（P＜0.05）；HFOV조여CMV조사망례수、상궤시간、기흉、지기관폐발육불량（BPD）、조산인시망막병（ROP）례수、조산인뇌실내출혈（IVH）급뇌실주위백질연화（PVL）례수비교，차이균무통계학의의（P＞0.05）。결론연합응용HFOV、PS、목서탄치료조산인폐투명막병가이개선기동맥혈기지표화호흡공능지표，개선기양합，유일정적추엄응용개치。
Objective To investigate the clinical application effect of different ventilation modes combined with pulmonary surfactant and mucosolvan in the treatment of preterm newborns with hyaline membrane disease (HMD). Methods 76 cases of preterm infants with HMD (Ⅲ-Ⅳgrade) from Xuzhou central hospital neonatal intensive care unit (neonatal intensive care unit, NICU) from 2013 January to 2015 February were randomly divided into two group, high frequency oscillatory ventilation (HFOV) group 40 cases and conventional mechanical ventilation (CMV) group 36 cases, at the beginning of mechanical ventilation, the two groups began to use the pulmonary surfactant (PS), while HFOV group used intravenous mucosolvan 30 mg/kg daily. The main observation was the comparison of blood gas indicators before and after mechanical ventilator, the indicators changes of related respiratory function and the complication rate, et al. Results PaO2, PaO2/FiO2, Oxygenation index (OI=100×MAP×FiO2/ PaO2) and arterial/alveolar oxygen partial pressure ratio (713×FiO2-PaCO2/0.8) were improved significantly in HFOV group compared with CMV group (P<0.05). There was no statistical significance between both groups in the number of deaths, ventilation time, gas leak syndrome, bronchopulmonary dysplasia (BPD), retinopathy of premature children (ROP), intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL). Conclusion High-frequency oscillatory ventilation mode combined with pulmonary surfactant and mucosolvan could improve arterial blood gas index and respiratory function index and improve oxygenation, it has application value and should be applied extensively.