Clinical Analysis Of High Frequency Oscillatory Ventilation Of Treatment Of Severe Neonatal Respiratory Distress Syndrome

Background:With the continuous improvement of perinatology,the survival rate of very lowl ultra-low premature infants has gradually increased,and the incidence of Neonatal Respiratory Distress Syndrome(NRDS)is also increasing.NRDS has become an important disease that threatens the survival and long-term prognosis of premature infants.Relevant studies have shown that Continuous Positive Airway Pressure(CPAP)and Intubation-surfactant-extubation(INSURE)techniques have ideal therapeutic effects for grade I and II NRDS children,but poor therapeutic effects for grade III and IV children often require invasive mechanical ventilation.Conventional Mechanical Ventilation(CMV)is a reasonable and effective method to treat NRDS with low tidal volume and appropriate positive end-expiratory pressure.However,it is not completely effective for refractory respiratory failure caused by severe NRDS,It is easy to cause barotrauma and volume injury,resulting in increased incidence of Bronchopulmonary Dysplasia(BPD).In the early 1970s,foreign scholars proposed the application of High Frequency Oscillatory Ventilation(HFOV).HFOV uses high frequency,low tidal volume and dispersion to exchange,which can quickly discharge Carbon Dioxide(CO2),is not to produce barotrauma,and can reduce the damage of high-concentration oxygen to tissues.However,at present,there is still no consistent conclusion about the treatment of HFOV and CMV which is more suitable for the treatment of NRDS.Objective:To compare the efficacy and safety of treatment of severe premature Respiratory Distress Syndrome(RDS)between HFOV and CMV,so as to provide basis for the selection of different ventilation modes in the clinical treatment of NRDS.Method:90 premature infants diagnosed as RDS in the Neonatal Intensive Care Unit(NICU)of Lanling County People’s Hospital from March 2017 to March 2019 were selected as the research object and randomly divided into control group(CMV group,n=45)and observation group(HFOV group n=45).The two groups of children were treated with conventional methods.The observation group was treated with HFOV and the control group was treated with CMV.The number of cases of evacuation from ventilator,mechanical ventilation time,oxygen supply time after evacuation average hospital stay,blood gas analysis,Oxygenation Index(01),clinical outcome and complications were recorded.To observe the difference of clinical effect of ventilator treatment between the two groups of children,the difference of Fi02,PH value,Arterial Oxygen Tension(PaO2),Arterial Carbon Dioxide Tension(PaCO2)and Ol at different time points,and the differences of complication.All the data in this study were processed by SPSS22.0 software.The counting data were expressed by mean ± standard deviation.The independent sample t test was used to compare the differences between groups.The measurement data was expressed in terms of rate and number of cases.The differences between groups were compared by X2 test or Fisher exact test,the difference was statistically significant(P<0.05)。Result:(1)There was no significant difference in general data and high-risk factors between the two groups(P>0.05).(2)The number of evacuation cases in the HFOV group after 120 hours of treatment was better than that in the CMV group.The average application time of the ventilator treatment,oxygen supply time after evacuation and average total hospitalization time in the HFOV group were all less than those in the CMV group,the difference was statistically significant(P<0.05).The number of evacuated ventilator cases,the number of family members who gave up treatment and the mortality rate of 0-24h,24-48h,48-72h,72-96h and 96-120h in both groups were not statistically significant(P>0.05).(3)Regarding the observation indexes of FiO2,PH value,PaO2 value,PaCO2 and OI values,there was no significant difference between the two groups before treatment(P>0.05).After the mechanical ventilation treatment,the above indexes of the two groups of children were significantly improved.The PH value and Pa02 value were significantly increased at 6 hours,12 hours,24 hours,and 48 hours after two types of mechanical ventilation,the FiO2,PaCO2,and 01 values were significantly decreased.Compared with the two methods at the same time,the HFOV group improved significantly compared to the CMV group(P<0.05).(4)After treatment,the incidence of BPD and Betinopathy of Prematurity(ROP)in the HFOV group was lower than that in the CMV group,and the difference was statistically significant(P<0.05).In HFOV and CMV group,Intraventricular Hemorrhage(IVH),Ventilator Associated Pneumonia(VAP),pulmonary hemorrhage,Periventricular Leukomalacia(PVL),symptomatic Patent Ductus Arteriosus(PDA),Pulmonary Air Leak(PAL)and neonatal Necrotizing Enterocolitis(NEC)were not statistically significant(P>0.05).Conclusion:Both HFOV and CMV are effective in the treatment of NRDS,but the treatment of severe NRDS by HFOV can shorten the time of applying a ventilator,shorten the time of symptom improvement and hospitalization,and the incidence of some complications is low.HFOV is an important measure to rescue severe NRDS and has a good clinical application prospect.