He Ming-Yuan, Lin Yu-Cong, Wu Lin-Lin, Shen Wei, Tang Li-Xia, Zhu Yao, Huang Jing, Lin Xin-Zhu
Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian 361001, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2021 Jan;23(1):18-24. doi: 10.7499/j.issn.1008-8830.2010115.
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.
A prospective randomized controlled trial was conducted for 101 preterm infants with NRDS, with a gestational age of ≤32 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.
There was no significant difference in the failure rate of ventilator weaning within 72 hours (8% vs 14%, > 0.05). The observation group had a significantly shorter duration of mechanical ventilation than the control group [(64±39) hours vs (88±69) hours, < 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 ( > 0.05).
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.
研究两种撤机策略用于高频振荡通气（HFOV）治疗早产儿新生儿呼吸窘迫综合征（NRDS）后的安全性。
对101例NRDS早产儿进行前瞻性随机对照试验，这些早产儿胎龄≤32周或出生体重≤1500g，于2019年1月1日至2020年6月30日入住厦门市妇幼保健院新生儿重症监护病房。婴儿接受HFOV作为首选治疗。将婴儿随机分为观察组（50例直接从HFOV撤机的婴儿）和对照组（51例在HFOV切换为传统机械通气后撤机的婴儿）。比较两组在72小时内撤机失败率、撤机前2小时及撤机后2小时和24小时血气参数变化、呼吸支持治疗、并发症发生率及出院结局。
72小时内撤机失败率无显著差异（8%对14%，P>0.05）。观察组机械通气时间明显短于对照组[（64±39）小时对（88±69）小时，P<0.05]。两组在机械通气时间、总吸氧时间、撤机前后血气参数、并发症发生率及出院结局方面无显著差异（P>0.05）。
对于NRDS早产儿，直接从HFOV撤机的策略安全可靠，可缩短有创机械通气时间，因此具有临床应用前景。
