欢迎访问《中国循证儿科杂志》官方网站，今天是
English Version
中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (2): 99-103.

• 论著 • 上一篇    下一篇

同步间歇指令通气支持下吸入氦氧混合气和空氧混合气治疗胎粪吸入综合征的随机对照试

马娟 李雪 陈龙 汪丽 赵锦宁 唐仕芳 史源   

  1. 第三军医大学大坪医院儿科 重庆，400042
  • 收稿日期:2015-11-20 修回日期:2016-04-21 出版日期:2016-04-25 发布日期:2016-04-21
  • 通讯作者: 史源

Randomized controlled trial of inhaling heliox and air oxygen mixture in meconium aspiration syndrom under the support of synchronized intermittent mandatory ventilation

MA Juan，LI Xue，CHEN Long,WANG Li,ZHAO Jin-ning, TANG Shi-fang,SHI Yuan   

  1. Department of Pediatrics，Daping Hospital，Third Military Medical University，Chongqing 400042，China
  • Received:2015-11-20 Revised:2016-04-21 Online:2016-04-25 Published:2016-04-21
  • Contact: SHI Yuan

PDF

1739

摘要：

目的 探讨胎粪吸入综合征（MAS）新生儿在同步间歇指令通气（SIMV）支持下吸入氦氧混合气（Heliox）和空氧混合气的疗效。方法 2014年3月1日至2015年5月30日在第三军医大学大坪医院NICU住院的MAS新生儿，以随机数字表法分为Heliox组和对照组，全部患儿均给予SIMV作为呼吸支持模式；Heliox组吸入Heliox 70（He 70%，O-2 30%）6 h后更换吸入空氧混合气（O-2 30%）；对照组吸入空氧混合气。主要观察指标为治疗期间氧合指数（OI）和拔管时间，次要观察指标为机械通气并发症发生率、NICU住院时间、血气分析、炎症反应指标、心肌损伤标志物、生后28 d和100 d时振幅整合脑电图（aEEG）结果。结果 Heliox组和对照组分别纳入33和31例。Heliox组OI显著高于对照组，差异有统计学意义（P＝0.022）, Heliox组拔管时间、机械通气并发症发生率及NICU住院时间均显著低于对照组,差异均有统计学意义（P分别为0.037,0.013和0.010）；两组呼吸支持后2、6、12、24、48 h时点血气分析指标（pH、HCO-3-1、BE、PaO-2 、PaCO-2 ）差异均有统计学意义（P均<0.05）； Heliox组6 h时点炎症反应指标（IL-6、IL-8、TNF-α、CRP）和24 h时点心肌损伤标志物（CK、 CK-MB）均较0 h时点降低，差异均有统计学意义（P均<0.05）。Heliox组生后28 d和100 d时aEEG检查神经发育重度异常发生率分别为9.1%和3.0%，显著低于对照组的25.8%和9.6%（P<0.05）。结论 在SIMV支持下吸入Heliox治疗MAS新生儿较空氧混合气具有良好的疗效，安全性好，值得深入研究。

Abstract:

Objective To investigate the curative effect of inhaling heliox and air oxygen mixture in meconium aspiration syndrome under the support of synchronized intermittent mandatory ventilation (SIMV). Methods Sixty-four children with MAS in NICU of the DaPing Hospital, Third Military Medical University from March 1st, 2014 to May 30th, 2015 were taken as samples. The children, who were treated with SIMV as respiratory support mode, were divided into Helio group (n=33) and control group (n=31) in accordance with the random number table. Heliox group inhaled Heliox 70 (He 70% O-2 30%) for 6 h after replacement of inhaling air oxygen mixture (30% O-2 ); Control group inhaled air oxygen mixed gas. Main outcome measures: oxygenation index (OI) during treatment and extubation time; Secondary outcome measures: incidence of the complications of mechanical ventilation, hospital stays in NICU, bood gas analysis, inflammation index and myocardial injury markers, amplitude integrated electroencephalography (aEEG) results. Results OI in the heliox group was significantly higher than that in the control group; the difference was statistically significant (P=0.022), and the extubation time, incidence of the complications of mechanical ventilation and hospital stays in NICU of heliox group were significantly lower than those of control group; the differences were statistically significant (P=0.037, 0.013 and 0.010). Blood gas analysis index (pH, HCO-3-, BE, PaO-2 , PaCO-2 ) in two groups (2, 6, 12, 24, 48 h) presented some discrepancy; the differences were statistically significant (P<0.05). The inflammation index (IL-6, IL-8, TNF-a CRP) at 6 h and myocardial injury markers (CK, CK-MB) at 24 h of the two groups were decreased compared with those at 0 h, and heliox group decreased more significantly compared with the control group; the differences were statistically significant (P<0.05). The aEEG abnormal checking rate of children born after 28 and 100 days of heliox group was 9.1% and 3.0%, significantly lower than 25.8% and 9.6% of the control group (P< 0.05). Conclusion Inhaling heliox has better curative effect and high security than inhaling air oxygen mixture for MAS under the support of SIMV, and it is worthy of further study.

中图分类号: