Abstract: Objective To analyze the effects of different ventilation methods during pulmonary surfactant(PS) administration on the treatment of severe neonatal respiratory distress syndrome(RDS),in order to provide reference for the treatment of RDS. Methods A total of 65 preterm infants who met the inclusion criteria were enrolled in this study,and were divided into manual ventilation group(n=32) and high frequency ventilation group(n=33).The changes of percutaneous partial pressure of O₂(tcPO₂) and CO₂(tcPCO₂₎,oxygenation index(OI)and respiratory index(RI) during PS administration were retrospectively analyzed,and the chest X-ray situation,mechanical ventilation time and related complications were also compared. Results During administration,tcPO₂ transiently decreased and tcPCO₂ increased.After administration,tcPO₂ rapidly increased,tcPCO₂ decreased in both groups.The changes of manual ventilation group were more obvious and had longer duration time(P＜0.05).Also,tcPO₂ and tcPCO₂ reached steady till 5 minutes to 15 minutes after PS administration,the high frequency ventilation group was earlier than the manual ventilation group(P＜0.05).At 1 hour,the high frequency ventilation group had lower OI and RI than the manual ventilation group(P＜0.05).The high frequency ventilation group had more conspicuous improvement of X-ray,shorter duration of mechanical ventilation than the manual ventilation group(P＜0.05).There were no significant differences on the complication incidence (intraventricular hemorrhage,bronchopulmonary dysplasia,air leak syndrome) (P＞0.05) between the two groups. Conclusion High frequency oscillatory ventilation during endotracheal PS injection can significantly reduce tcPO₂,tcPCO₂ fluctuation,and improve the neonatal pulmonary compliance and oxygenation in severe RDS neonates more effectively,thereby shortening the duration time for mechanical ventilation.

Key words: preterm infants, respiratory distress syndrome, pulmonary surfactant, high frequency oscillatory ventilation

摘要： 目的 分析在肺表面活性物质(PS)给药过程中联合不同通气方式对重症新生儿呼吸窘迫综合征(RDS)的临床疗效,为临床诊治提供参考依据。方法 2015年12月—2017年5月收集65例符合纳入标准RDS早产儿,其中手动通气组32例,高频通气组33例,回顾性分析两组患儿气管内注入PS经皮氧分压(tcPO₂)和二氧化碳分压(tcPCO₂)变化、氧合指数(OI)、呼吸指数(RI)、胸部X线改善情况、机械通气时间及相关并发症。结果 PS给药时两组均出现短暂tcPO₂降低、tcPCO₂升高,给药后tcPO₂快速升高、tcPCO₂降低,手动通气组比高频通气组变化显著且持续时间长,差异有统计学意义(P＜0.05)。在5～15 min时二者达到稳定状态,高频通气组先于手动通气组; 1 h时高频通气组OI、RI均低于手动通气组,差异均有统计学意义(P＜0.05)。高频通气组PS后X线表现显著改善,且机械通气时间低于手动通气组,差异均具有统计学意义(P＜0.05)。两组患儿并发症(脑室内出血、支气管肺发育不良、气漏综合征)发生率比较差异无统计学意义(P＞0.05)。结论 高频振荡通气下气管内注入PS可更显著减少tcPO₂、tcPCO₂波动;更有效改善重症RDS新生儿肺顺应性和氧合功能,缩短机械通气时间。

关键词: 早产儿, 呼吸窘迫综合征, 肺表面活性物质, 高频振荡通气