早产儿呼吸窘迫综合征高频振荡通气后两种撤机方式的安全性研究：前瞻性随机对照试验

Safety of two ventilator weaning strategies after high-frequency oscillatory ventilation in preterm infants with respiratory distress syndrome: a prospective randomized controlled trial

摘要:

目的 探讨高频振荡通气（HFOV）治疗早产儿呼吸窘迫综合征（RDS）后两种撤机方式的安全性。方法 前瞻性纳入2019年1月1日至2020年6月30日厦门市妇幼保健院新生儿科重症监护病房（NICU）收治的胎龄≤ 32⁺⁶周或体重≤ 1 500 g、首选HFOV治疗的RDS早产儿101例，随机分为HFOV直接撤机组（观察组）50例，HFOV转为常频机械通气撤机组（对照组）51例。比较两组患儿撤机后72 h内的撤机失败率，撤机前2 h、撤机后2 h、撤机后24 h的血气分析各指标，比较两组呼吸支持治疗情况、并发症的发生率及出院时的转归情况。结果 观察组和对照组撤机失败率差异无统计学意义（8% vs 14%，P > 0.05）。观察组有创机械通气时间较对照组缩短[（64±39）h vs（88±69）h，P < 0.05]。两组患儿总机械通气时间、总用氧时间、撤机前后的血气分析各指标、并发症发生率、出院时转归情况差异均无统计学意义（均P > 0.05）。结论 对于RDS早产儿，使用HFOV后采取直接撤机策略是安全可靠的，且可减少有创呼吸机使用时间，值得临床推广应用。

Abstract:

Objective To study the safety of two ventilator weaning strategies after high-frequency oscillatory ventilation (HFOV) for the treatment of neonatal respiratory distress syndrome (NRDS) in preterm infants. Methods A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32⁺⁶ weeks or a birth weight of ≤1 500 g, who were admitted to the neonatal intensive care unit of Xiamen Maternal and Child Health Hospital from January 1, 2019 to June 30, 2020. The infants underwent HFOV as the preferred treatment. The infants were randomly divided into an observation group (50 infants with direct weaning from HFOV) and a control group (51 infants with weaning after HFOV was switched to conventional mechanical ventilation). The two groups were compared in terms of failure rate of ventilator weaning within 72 hours, changes in blood gas parameters at 2 hours before weaning and at 2 and 24 hours after weaning, respiratory support therapy, incidence rates of complications, and outcome at discharge. Results There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, P > 0.05). The observation group had a significantly shorter duration of mechanical ventilation than the control group [(64±39) hours vs (88±69) hours, P < 0.05]. There were no significant differences between the two groups in the duration of mechanical ventilation, total oxygen supply time, blood gas parameters before and after ventilator weaning, incidence rates of complications, and outcome at discharge (P > 0.05). Conclusions For preterm infants with NRDS, the strategy of weaning directly from HFOV is safe and reliable and can reduce the duration of invasive mechanical ventilation, and therefore, it holds promise for clinical application.