高频通气治疗新生儿呼吸衰竭的证据及临床应用

目的多数导致新生儿呼吸衰竭需要机械通气的疾病都可用高频通气（HFV）或常频通气（CMV）,但哪种模式更适用,目前尚无统一认识。本文对已有的文献进行评估,从循证医学角度对HFV在新生儿呼吸衰竭方面的使用进行评价。方法对新生儿使用HFV及CMV的研究进行系统评价。结果新生儿HFV组与CMV组比较,在慢性肺疾病（CLD）、气胸、颅内出血的发生率及两组间的病死率上无显著差异;但是在有持续性肺动脉高压（PPHN）存在时,吸入N0治疗时与HFV联合应用比与CMV联合应用更有利于低氧性呼吸衰竭的氧合作用。结论现有的循证医学证据表明,新生儿呼吸衰竭发生时选择HFV并不比CMV模式更为有效,但是PPHN存在时将N0与HFV联合应用更为有效。

High frequency ventilation in neonatal respiratory failure and clinical application of evidence

Objective To summarize the evidence on the efficacy of elective high frequency ventilation compared with conventional ventilation in neonatal infants with respiratory distress syndrome.MethodsTo be included in the data synthesis,studies had to be randomized controlled trials comparing elective high frequency ventilation with conventional ventilation in neonatal infants.ResultsNo difference in the incidence of chronic lung disease,air leak,intraventricular hemorrhage（IVH） and mortality was found between both types of ventilation.But the use of inhaled nitric oxide and high-frequency oscillatory ventilation in severe,persistent pulmonary hypertension of the newborn（PPHN） improves oxygenation.Conclusion Available evidence showed that HFV mode seemed not superior than CMV mode in the treatment of neonatal infants with respiratory distress syndrome,but the use of inhaled nitric oxide and high-frequency oscillatory ventilation in PPHN is better.