本文選題：高頻振蕩通氣 + 治療時(shí)機(jī)��； 參考：《青島大學(xué)》2013年碩士論文

【摘要】：目的探討高頻振蕩通氣(High-frequency oscillatory ventilation, HFOV)的治療時(shí)機(jī)選擇對(duì)新生幾呼吸衰竭(Neonate respiratory failure, NRF)治療效果的影響。 方法收集青島市婦女兒童醫(yī)院新生兒重癥監(jiān)護(hù)室(NICU)2010年1月-2012年9月應(yīng)用HFOV治療的新生兒43例及煙臺(tái)市毓璜頂醫(yī)院NICU2010年8月-2012年12月應(yīng)用HFOV治療的新生兒31例。根據(jù)是否首先選用HFOV治療,分為首選HFOV組和非首選HFOV組,搜集入選患兒的基本資料、評(píng)估患兒應(yīng)用HFOV前的疾病嚴(yán)重程度、記錄呼吸機(jī)使用情況,記錄患兒應(yīng)用HFOV前及治療后2、6、12、24h的血?dú)夥治鼋Y(jié)果、呼吸機(jī)參數(shù)并計(jì)算氧合參數(shù),觀察并記錄患兒的并發(fā)癥、治愈率、死亡率、兩組治愈患兒的住院時(shí)間及住院費(fèi)用等。 結(jié)果應(yīng)用HFOV治療的新生兒共74例,其中首選HFOV組22例,非首選HFOV組52例。兩組應(yīng)用呼吸機(jī)的原發(fā)病情況及應(yīng)用HFOV治療前的疾病嚴(yán)重程度無顯著性差異,具有可比性。首選HFOV組吸入氧濃度(FiO2)0.6上機(jī)持續(xù)時(shí)間、上機(jī)總持續(xù)時(shí)間、撤HFOV后有創(chuàng)機(jī)械通氣時(shí)間及無創(chuàng)通氣時(shí)間、撤機(jī)后吸氧時(shí)間均比非首選HFOV組短,差異有顯著性(t分別為-3.78、-2.87、-3.47、-2.03、-2.40,P均0.05)。兩組患兒應(yīng)用HFOV治療后氧分壓(Pa02)、二氧化碳分壓(PaCO2)PH值均改善,差異有統(tǒng)計(jì)學(xué)意義(F分別為37.59、34.98、25.14,P均0.05),氧合指數(shù)(OI)、動(dòng)脈肺泡氧分壓比值(a/A)、肺泡-動(dòng)脈氧分壓差(A-aDO2)均好轉(zhuǎn),差異有顯著性(F分別為32.54、41.09、25.89,P均0.05),平均氣道壓(MAP).Fi02下調(diào)順利,有顯著性差異(F分別為12.17、21.10,P均0.05),兩組間比較差異無統(tǒng)計(jì)學(xué)意義。首選HFOV組比非首選HFOV且氣胸發(fā)生率低,差異有顯著性(X2=4.05,P0.05),在肺出血、顱內(nèi)出血、支氣管肺發(fā)育不良(BPD)、腦室周白質(zhì)軟化(PVL)等并發(fā)癥方面無顯著性差異。首選HFOV組22例,治愈14例(63.64%),死亡7例(31.82%)；非首選HFOV組52例,治愈23例(44.23%),死亡14例(26.92%),兩組在死亡率上無差異。首選HFOV組比非首選HFOV組治愈患兒的住院時(shí)間短、住院費(fèi)用低,差異有顯著性。 結(jié)論1.首選HFOV治療新生兒呼吸衰竭總上機(jī)持續(xù)時(shí)間短,撤HFOV后的有創(chuàng)及無創(chuàng)機(jī)械通氣時(shí)間縮短,減少了高濃度吸氧時(shí)間及撤機(jī)后吸氧時(shí)間。 2.首選HFOV治療新生兒呼吸衰竭可降低氣胸發(fā)生率。 3.首選HFOV治療新生兒呼吸衰竭可以減少住院天數(shù),降低住院費(fèi)用。 目的探討高頻振蕩通氣(HFOV)治療的呼吸衰竭新生兒24h內(nèi)動(dòng)態(tài)氧合參數(shù)的變化及其對(duì)預(yù)后判斷的價(jià)值。 方法收集青島市婦女兒童醫(yī)院NICU2010年1月-2012年9月應(yīng)用HFOV治療的新生兒43例及煙臺(tái)市毓璜頂醫(yī)院NICU2010年8月-2012年12月應(yīng)用HFOV治療的新生兒31例。評(píng)估患兒應(yīng)用HFOV治療前及治療后6、12h的呼吸窘迫評(píng)分。記錄患兒應(yīng)用HFOV前及治療后2、6、12、24h的PH值、PaO2、PaCO2、MAP、FiO2,并計(jì)算各時(shí)段的a/A、OI、A-aDO2。 結(jié)果共收集應(yīng)用HFOV治療的患兒74例,生存組53例,死亡組21例。兩組應(yīng)用HFOV治療前呼吸窘迫評(píng)分無顯著性差異,生存組治療后6、12h呼吸窘迫評(píng)分與治療前相比差異有顯著性(t=10.82、14.51,P值均0.05),死亡組與治療前比較無明顯差異(P0.05)。應(yīng)用HFOV后6、12h,生存組呼吸窘迫評(píng)分比死亡組低,差異有統(tǒng)計(jì)學(xué)意義(t=-11.25、-6.31,P0.05)。生存組HFOV治療24h內(nèi)PaO2、PaCO2、 PH、OI、a/A、A-aDO2明顯改善,均較治療前比較有差異(F分別為80.70、31.77、38.08、69.48、84.46、68.79, P均0.05),MAP、FiO2治療后24h內(nèi)與治療前相比差異亦明顯改善,有顯著性差異(F分別38.99、56.80,P0.05)。雖然死亡組中應(yīng)用HFOV2h后,PH較治療前改善,差異有統(tǒng)計(jì)學(xué)意義(t=5.63,P0.05),應(yīng)用HFOV6h后,PaCO2與治療前相比,差異有顯著性(t=8.43,P0.05),應(yīng)用HFOV6、12h后,MAP與治療前相比,差異有顯著性(t=5.00、5.47,P值均0.05),但是死亡組應(yīng)用HFOV后24h內(nèi),PaO2、PaCO2、PH、OI、a/A、A-aDO2、MAP、FiO2較治療前無明顯好轉(zhuǎn),總體差異無統(tǒng)計(jì)學(xué)意義。 結(jié)論HFOV治療的新生兒呼吸衰竭24h內(nèi)動(dòng)態(tài)氧合參數(shù)的監(jiān)測(cè)可以幫助判斷預(yù)后,但仍需結(jié)合臨床實(shí)踐。
[Abstract]:Objective to investigate the effect of the treatment timing of High-frequency oscillatory ventilation (HFOV) on the therapeutic effect of new respiratory failure (Neonate respiratory failure, NRF).
Methods to collect 43 newborns with HFOV treatment in the neonatal intensive care unit (NICU) of Qingdao women's and children's Hospital in September January 2010, and 31 newborns with HFOV treatment in Yuhuangding hospital, Yantai, August -2012 December. According to whether HFOV treatment was selected first, the first choice HFOV group and non preferred HFOV group were collected and collected. The children's basic data were selected to assess the severity of the disease before HFOV, record the use of the ventilator, record the results of the blood gas analysis before and after HFOV, the parameters of the ventilator and calculate the oxygenation parameters, observe and record the complications of the children, the cure rate, the death rate, and the two groups to cure the children's hospitalization time and stay. Hospital expenses and so on.
Results a total of 74 newborns were treated with HFOV, of which 22 were the first choice in group HFOV and 52 were not the first choice in group HFOV. There was no significant difference between the two groups and the severity of the disease before the application of HFOV. The first choice of the HFOV group inhaled oxygen concentration (FiO2) 0.6 on the duration of the machine, the total duration of the upper machine, and the HFOV after the withdrawal of HFOV. The time of mechanical ventilation and non invasive ventilation time were shorter than those in the non first HFOV group, and the difference was significant (t was -3.78, -2.87, -3.47, -2.03, -2.40, P 0.05 respectively). The two groups had improved oxygen partial pressure (Pa02) after HFOV treatment, and the pH value of carbon dioxide partial pressure (PaCO2) were improved. The difference was statistically significant (F was respectively, P 0.05), oxygenation index (OI), arterial alveolar oxygen partial pressure ratio (a/A), Alveolar arterial oxygen pressure difference (A-aDO2) were all improved, the difference was significant (F respectively 32.54,41.09,25.89, P 0.05), the average airway pressure (MAP).Fi02 downregulation was smooth, there were significant differences (F respectively 12.17,21.10, P are 0.05), the two groups had no statistical difference. Preferred There were significant differences in the incidence of HFOV and pneumothorax (X2=4.05, P0.05). There were no significant differences in the complications of pulmonary hemorrhage, intracranial hemorrhage, bronchopulmonary dysplasia (BPD) and periventricular white matter softening (PVL). The first choice HFOV group was 22 cases, 14 cases were cured (63.64%), 7 cases died (31.82%), 52 cases of non preferred HFOV group, 23 cases (44.23%) cured (44.23%), death. 14 cases (26.92%) died. There was no difference in mortality between the two groups. The first group HFOV was shorter than the non preferred HFOV group, and the hospitalization time was shorter and the hospitalization expenses were lower.
Conclusion 1. the first choice of HFOV in the treatment of neonatal respiratory failure is short, and the duration of invasive and noninvasive mechanical ventilation after the withdrawal of HFOV reduces the time of high concentration of oxygen inhalation and the time of oxygen inhalation after the withdrawal of the machine.
2. the first choice of HFOV is to reduce the incidence of pneumothorax in the treatment of neonatal respiratory failure.
3. the first choice of HFOV treatment of neonatal respiratory failure can reduce hospitalization days and reduce hospitalization expenses.
Objective to investigate the changes of dynamic oxygenation parameters in 24h of neonates with respiratory failure treated by high frequency oscillatory ventilation (HFOV) and their prognostic value.
Methods 43 newborns who were treated with HFOV in Qingdao women's and children's Hospital, January -2012 years, and 31 neonates with HFOV treatment in December August -2012 in Yuhuangding hospital, Yantai, were collected. The respiratory distress scores of 6,12h before and after HFOV treatment were evaluated. The children were used before and after the treatment of 2,6, 12,24h's pH, PaO2, PaCO2, MAP, FiO2, and calculate a/A, OI, A-aDO2. of each period.
Results 74 children were treated with HFOV, 53 cases in survival group and 21 cases in death group. There was no significant difference in the respiratory distress score of the two groups before treatment. The 6,12h respiratory distress score in the survival group was significantly different from that before the treatment (t=10.82,14.51, P value was 0.05), and there was no significant difference between the death group and the pre treatment group (P0.05). After HFOV 6,12h, the respiratory distress score in the survival group was lower than that in the death group. The difference was statistically significant (t=-11.25, -6.31, P0.05). HFOV in the survival group was significantly improved in 24h PaO2, PaCO2, PH, OI, a/A. The difference was significantly improved (F 38.99,56.80, P0.05). Although after the application of HFOV2h in the death group, the difference was statistically significant (t=5.63, P0.05). After the application of HFOV6h, the difference was significant (t=8.43, P0.05) compared with before the treatment (t=8.43, P0.05). After the application of HFOV6,12h, there was a significant difference. 0,5.47 and P values were all 0.05), but in the death group after HFOV, 24h, PaO2, PaCO2, PH, OI, a/A, A-aDO2, MAP, and MAP had no significant improvement compared with those before treatment, and the overall difference was not statistically significant.
Conclusion monitoring of dynamic oxygenation parameters in 24h of neonatal respiratory failure treated with HFOV can help to predict prognosis, but it still needs to be combined with clinical practice.

【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R722.1

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