Clinical Study Of Early High Frequency Oscillatory Ventilation Combined With Pulmonary Surfactant For The Treatment Of Respiratory Distress Syndrome In Preterm Neonates

Objective:To evaluate the effectiveness of early high frequency oscillatory ventilation(HFOV) combined with pulmonary surfactant(PS) in the treatment of premature infant with respiratory distress syndrome(RDS). Methods:Totle 70 premature infants with RDS were selected from Jan to Sep in 2013, and they were randomly divided into two groups: HFOV group(n=36) which was given early high frequency oscillatory ventilation(HFOV) combined with pulmonary surfactant(PS) therapy and CMV group(n=34) which was given normal frequency oscillatory ventilation combined with pulmonary surfactant(PS) therapy, based on their gestational age, weight, and age etc. Fraction of inspiratory oxygen(Fi O2), oxygenation index(OI), blood gas values(Pa O2 and Pa CO2), and dynamic lung compliance(Cydn) were determined before treatment and after 2 hours, 6 hours, 12 hours, 24 hours and 48 hours of treatment. Observe the emergence of complications such as pulmonary air leak syndrome(PAL), pulmonary haemorrhage, bronchopulmonary dysplasia( BPD) etc. The treatment outcomes and requirements of exogenous pulmonary surfactant of two groups were compared too. Results:There were no significant differences in the fraction of inspiratory oxygen(Fi O2), oxygenation index(OI), arterial blood gas analysis(Pa O2 and Pa CO2), and dynamic lung compliance(Cydn) between the two groups at the beginning of the treatment. The fraction of inspiratory oxygen(Fi O2) declined rapidly in HFOV group(P<0.05) since 2 hours after treatment. More statistically significant difference between the two groups came out after 6 hours of treatment(P<0.01), In the whole 48 hours treatment process, the fraction of inspiratory oxygen(Fi O2) in HFOV group was significantly lower than that of CMV group(P<0.05). The Pa O2 in HFOV group increased significantly compared with CMV group after 2 hours treatment(P<0.05).The oxygenation index(OI) and Pa CO2 in HFOV group decreased after treatment for 2 hours, which were significantly lower than that of CMV group(P<0.05),after 6 hours treatment,the difference became more significant(P<0.01).The dynamic lung compliance(Cydn) improved in both group after using PS.The effect in HFOVgroup was more significant than CMV group in 24 hours(P<0.05).The requirement of more instillations of PS in HFOV group was reduced compared with CMV group(P<0.05).The incidence of air leak and BPD in CMV group was higher than HFOV group(P<0.05). The number of cured infants in HFOV group was significantly higher than CMV group(P<0.05). Conclusions:The therapy of early HFOV+PS is more safe and effective than CMV+PS in treatment of NRDS in premature infant.It improves the oxygenation faster, downgrads the oxygen concentration more efficiently, reduces the requirement of PS and emergence of pulmonary complications.