Normal Frequency Mechanical Ventilation And High-frequency Mechanical Ventilationin The Treatment Of Respiratory Distress Syndrome, Neonatal Meconium Aspiration Syndrome, Neonatal Pneumothorax

Objective: To evaluate the efficacy and safety of frequency mechanical ventilation and normal frequency mechanical ventilation for treatment of neonatal respiratory distress syndrome, meconium aspiration syndrome, and pneumothorax.Methods: 190 patients who need mechanical ventilation from January 2011 to November 2013 in Tai’an City Children’s Hospital NICU department were enrolled in the study. Of which 60 cases of neonatal respiratory distress syndrome(Observer group: high-frequency ventilator 30 cases; Control group: normal frequency ventilator 30 cases), 64 cases of neonatal meconium aspiration syndrome(Observer group: high-frequency ventilator 32 cases; Control group: normal frequency ventilator 32 cases), neonatal pneumothorax treated by thoracic drainage 66 cases(Observer group: high-frequency ventilator 33 patients; Control group: normal frequency ventilator 33 cases), Servie ventilator, SIMV mode was used in normal frequency of respiratory ventilator group. Stephen ventilator was used in the high-frequency mechanical ventilation group. The changes of the neonate’s inhaled oxygen concentration, partial pressure of oxygen, carbon dioxide partial pressure, mean airway pressure, and calculates the above-mentioned time points lung oxygenation index, arterial- alveolar oxygen partial pressure ratio(a/APO2), oxygenation index(OI), arterial oxygen tension and inspired oxygen concentration ratio(Pa O2/Fi O2) on 0、2、6、12、24 hours five time points were compared between two groups. We also compared the incidence of chronic lung disease, intracranial hemorrhage, infection, pulmonary hemorrhage, retinopathy, patent ductus arteriosus and other complications between two groups.Result 1. Children with neonatal respiratory distress syndrome, neonatal meconium aspiration syndrome, and neonatal pneumothorax were treated by normal frequency mechanical ventilation and high-frequency mechanical ventilation, Gestational age, birth weight, Apgar score, the water level situation when children were born, mode of delivery, and age between two groups were not statistically significant(P> 0.05), the results are comparable.2. The ventilator data of different time points when we treat NRDS, MAS, Pneumothorax by using high frequency mechanical ventilation and normal frequency mechanical ventilation are repeated measures and done analysis of variance. The mean difference of inspired oxygen concentration, oxygen partial pressure, carbon dioxide partial pressure, airway pressure, arterial- alveolar oxygen tension ratio(a/APO2), oxygenation index(OI), arterial partial pressure of oxygen and inhaled oxygen concentration ratio(Pa O2/Fi O2) among the time point of 2h、6h、 12h、24h was statistically significant compared with the point of 0h(P <0.05).3. There were statistically significant(P <0.05) between high-frequency group and frequency groups, the differences in the mean of inhaled oxygen concentration, partial pressure of oxygen, partial pressure of carbon dioxide, average airway pressure, arterial-alveolar partial pressure of oxygen ratio(a / APO2), oxygenation index(OI), arterial partial pressure of oxygen and inhaled oxygen concentration ratio(Pa O2/Fi O2) in the same time point. These three diseases were treated through normal frequency mechanical ventilation and high-frequency mechanical ventilation, after treatment on the ventilator for 2h,Pa CO2 began to decline, Pa O2 began to rise, inspired oxygen concentration began to decrease, Pa O2/Fi O2 and a/APO2 appears began to rise, OI decreased when compared to the beginning, with the treatment time increases, the different time points repeated measures analysis of variance, and seek different F values, P values, the mean difference between each time point were statistically significant(P <0.05). After using high-frequency mechanical ventilation and normal frequency mechanical ventilation treatment for 6 hours, 12 hours, 24 hours, The Pa CO2 and inspired oxygen concentration of the HFOV group decreased significantly, and Pa O2、Pa O2/Fi02、 a/APO2 increased significantly when compare to the CMV group(P <0.05), OI significantly decreased when compared to the beginning of on the machine(P <0.05). No significant difference were found in the NRDS cure rate among these three diseases using two mechanical ventilation therapy(x2 = 0.218,p = 0.640)and complications(x2 = 2.411, p = 0.121), there were no statistically significant in cure rate of pneumothorax between two groups(x2 = 0.129, p = 0.720) and the cure rate of MAS(x2 = 0.161, p = 0.689), but high-frequency mechanical ventilation could decrease complications significantly(x2 = 9.035, p = 0.003).Conclusions and discussion: Compared to CMV group, HFOV can quickly improve the oxygen situation and does not increase the incidence of complications when treating NRDS, MAS, neonatal pneumothorax.