本文選題：高頻振蕩通氣 + 機(jī)械通氣��； 參考：《重慶醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的比較高頻振蕩通氣和傳統(tǒng)機(jī)械通氣治療新生兒呼吸衰竭的治療效果。 方法選取2011年10月至2013年12月來我院新生兒重癥監(jiān)護(hù)病房（NICU）進(jìn)行住院治療的呼吸衰竭患兒112例，分為高頻振蕩通氣治療組（HFOV組）和傳統(tǒng)機(jī)械通氣治療組（CMV組）。兩組患兒在給予相同抗生素進(jìn)行抗感染和營養(yǎng)支持治療的基礎(chǔ)上，分別給予高頻振蕩通氣治療和傳統(tǒng)機(jī)械通氣治療，觀察兩組患兒治療前后平均動(dòng)脈壓、心率、氧分壓（PaO2）、氧飽和度（SaO2）和二氧化碳分壓（PaCO2）等指標(biāo)的變化，比較兩種方法治療6h、12h、24h后患兒氧濃度（FiO2）、氧合指數(shù)（OI）和動(dòng)脈肺泡氧分壓比(a/APaO2)的差異，以及治療后的并發(fā)癥及轉(zhuǎn)歸情況。 結(jié)果高頻振蕩通氣和傳統(tǒng)機(jī)械通氣對(duì)呼吸衰竭患兒治療前后平均動(dòng)脈壓和心率無顯著的改變（P0.05）；與治療前相比，高頻振蕩通氣治療組和機(jī)械通氣治療組治療后氧分壓（PaO2）和氧飽和度（SaO2）均顯著升高，差異有統(tǒng)計(jì)學(xué)意義（P0.05），，且與傳統(tǒng)機(jī)械通氣治療組相比，應(yīng)用高頻振蕩通氣治療后氧分壓（t=2.97，P0.05）和氧飽和度（t=2.66，P0.05）升高更顯著，差異具有明顯的統(tǒng)計(jì)學(xué)意義；與治療前相比，兩種方法治療后二氧化碳分壓（PaCO2）均明顯降低，統(tǒng)計(jì)學(xué)差異顯著（P0.05），且與傳統(tǒng)機(jī)械通氣治療組相比，應(yīng)用高頻振蕩通氣治療后二氧化碳分壓降低更顯著（t=4.5，P0.05），差異具有統(tǒng)計(jì)學(xué)意義。對(duì)應(yīng)用高頻振蕩通氣和傳統(tǒng)機(jī)械通氣治療后呼吸衰竭患兒肺氧合功能的比較發(fā)現(xiàn)，治療前兩組患兒在氧濃度（FiO2）、氧合指數(shù)（OI）和動(dòng)脈肺泡氧分壓比(a/APaO2)方面無差異（P0.05）；與治療前相比，傳統(tǒng)機(jī)械通氣治療后6h氧濃度（FiO2）降低（P0.05），12h、24h后降低效果更顯著（P0.05），呈現(xiàn)時(shí)間依賴性；而高頻振蕩通氣治療后與治療前相比降低更明顯（P0.05），且與傳統(tǒng)機(jī)械通氣治療組相比，在治療后同一時(shí)間高頻振蕩通氣組氧濃度（FiO2）較低，6h、12h、24h兩組比較分別為（t=5.04，P0.05）、（t=5.6，P0.05）、（t=6.84，P0.05），差異有統(tǒng)計(jì)學(xué)意義；與治療前相比，傳統(tǒng)機(jī)械通氣治療后6h氧合指數(shù)（OI）明顯降低（P0.05），12h、24h后降低更顯著（P0.05），呈現(xiàn)時(shí)間依賴性；高頻振蕩通氣治療后與治療前相比降低更明顯（P0.05），也呈現(xiàn)時(shí)效依賴關(guān)系，且與傳統(tǒng)機(jī)械通氣治療組相比，在治療后同一時(shí)間高頻振蕩通氣組氧合指數(shù)（OI）較低，6h、12h、24h兩組比較分別為（t=3.35，P0.05）、（t=4.56，P0.05）、（t=5.41，P0.05），差異具有統(tǒng)計(jì)學(xué)意義；與治療前相比，傳統(tǒng)機(jī)械通氣治療后6h動(dòng)脈肺泡氧分壓比(a/A PaO2)明顯升高（P0.05），12h、24h后升高更顯著（P0.05），呈現(xiàn)時(shí)間依賴性；高頻振蕩通氣治療后與治療前相比升高更明顯（P0.05），也呈現(xiàn)時(shí)效依賴關(guān)系，且與傳統(tǒng)機(jī)械通氣治療組相比，在治療后同一時(shí)間高頻振蕩通氣組動(dòng)脈肺泡氧分壓比(a/APaO2)較高，6h、12h、24h兩組比較分別為（t=7.82，P0.05）、（t=3.69，P0.05）、（t=2.78，P0.05），差異具有統(tǒng)計(jì)學(xué)意義；高頻振蕩通氣治療組和傳統(tǒng)機(jī)械通氣治療組在并發(fā)顱內(nèi)出血和呼吸機(jī)相關(guān)性肺炎方面無顯著差異（P0.05），但相比高頻振蕩通氣治療組，傳統(tǒng)機(jī)械通氣治療組氣胸發(fā)生率明顯增高，差異具有統(tǒng)計(jì)學(xué)意義（P0.05），高頻振蕩通氣治俞率明顯高于傳統(tǒng)機(jī)械通氣，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論相比傳統(tǒng)機(jī)械通氣，高頻振蕩通氣改善肺通氣、肺換氣以及氧合功能效果更明顯，可明顯提高治愈率、減少并發(fā)癥、降低死亡率。
[Abstract]:Objective To compare the effects of high frequency oscillatory ventilation and traditional mechanical ventilation on neonatal respiratory failure .

Methods 112 patients with respiratory failure hospitalized in the neonatal intensive care unit ( NICU ) from October 2011 to December 2013 were divided into high frequency oscillatory ventilation therapy group ( HFOV group ) and traditional mechanical ventilation treatment group ( CMV group ) . The changes of mean arterial pressure , heart rate , oxygen partial pressure ( PaCO 2 ) , oxygen saturation ( SaO2 ) and carbon dioxide partial pressure ( PaCO 2 ) were observed in two groups . The difference of oxygen concentration ( FiO2 ) , oxygenation index ( OI ) and pulmonary alveolar oxygen partial pressure ratio ( a / APaO2 ) were compared between two groups .

Results High - frequency oscillatory ventilation and traditional mechanical ventilation had no significant changes in mean arterial pressure and heart rate before and after treatment ( P0.05 ) .
Compared with the traditional mechanical ventilation therapy group , the difference was significant ( P0.05 ) , and the oxygen partial pressure ( t = 2.97 , P0.05 ) and oxygen saturation ( t = 2.66 , P0.05 ) were higher than those in the traditional mechanical ventilation treatment group .
Compared with the traditional mechanical ventilation therapy group , there was no significant difference between the two methods ( P0.05 ) . Compared with the traditional mechanical ventilation treatment group , there was no significant difference between the two groups ( t = 4.5 , P0.05 ) . The difference of the oxygen concentration ( FiO2 ) , the oxygen index ( OI ) and the pulmonary alveolar oxygen partial pressure ( a / APaO2 ) was not significant in the two groups before treatment ( P0.05 ) .
Compared with the prior therapy , the oxygen concentration ( FiO2 ) decreased ( P0.05 ) , 12h and 24h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time dependence was presented .
Compared with the traditional mechanical ventilation treatment group , the oxygen concentration ( FiO2 ) of high frequency oscillation ventilation group was lower at the same time after treatment ( P0.05 ) , and the difference was significant ( t = 5.06 , P0.05 ) , ( t = 6.84 , P0.05 ) .
Compared with the prior therapy , the oxygenation index ( OI ) was significantly decreased ( P0.05 ) , 12 h and 24 h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time dependence was presented .
Compared with the traditional mechanical ventilation therapy group , the oxygenation index ( OI ) of high frequency oscillatory ventilation group was lower , 6h , 12h , 24h after treatment ( t = 3.35 , P0.05 ) , ( t = 4.56 , P0.05 ) , ( t = 5.41 , P0.05 ) , and the difference was statistically significant .
Compared with the prior therapy , the pulmonary alveolar oxygen partial pressure ratio ( a / A _ 2 ) increased significantly ( P0.05 ) , 12 h and 24 h after the traditional mechanical ventilation treatment ( P0.05 ) , and the time - dependence was presented .
Compared with the traditional mechanical ventilation treatment group , the alveolar oxygen partial pressure ratio ( a / APaO2 ) of the high frequency oscillatory ventilation group was higher , 6h , 12h and 24h after the treatment compared with the traditional mechanical ventilation treatment group ( t = 7.82 , P0.05 ) , ( t = 3.69 , P0.05 ) , ( t = 2.78 , P0.05 ) , and the difference was statistically significant ;
Compared with the traditional mechanical ventilation therapy group , the incidence of pneumothorax in the traditional mechanical ventilation therapy group was significantly higher than that in the traditional mechanical ventilation treatment group ( P0.05 ) .

Conclusion Compared with traditional mechanical ventilation , high - frequency oscillatory ventilation can improve lung ventilation , lung ventilation and oxygenation . It can obviously improve the cure rate , reduce the complications and reduce the mortality rate .
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R722.1

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