两种通气方式治疗新生儿呼吸窘迫综合征的临床疗效比较

Comparative study of two ventilation methods in the treatment of neonatal respiratory distress syndrome

目的观察肺表面活性物质(PS)联合经鼻持续正压通气(NCPAP)和肺表面活性物质联合经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效,为NRDS优化治疗方案积累经验和提供参考。方法选取2016年7月—2017年12月杭州市妇产科医院收治的NRDS患儿122例,随机分为PS联合NCPAP组和PS联合NIPPV组,每组各61例,对比2组患儿血pH值、动脉血氧分压(PaO_2)、呼气末正压(positive end expiratory pressure,PEEP)、血二氧化碳分压(PaCO_2)、吸入氧浓度(FiO_2)及气漏、鼻损伤等并发症发生率,并进行统计分析。结果组内比较:2组治疗后24 h分别与治疗前血pH值、PaO_2、PEEP、PaCO_2及FiO_2值比较差异均有统计学意义(均P <0. 05);组间比较:2组治疗后24 h血p H值、PaO_2、PEEP、PaCO_2及FiO_2值比较差异均有统计学意义(均P <0. 05); PS联合NIPPV组并发症发生率低于PS联合NCPAP组,差异有统计学意义(P <0. 05)。结论PS联合使用NIPPV及NCPAP均有助于改善NRDS患儿动脉血气相关指标,并可以有效地降低并发症的发生率,相比较而言,PS联合使用NIPPV的临床疗效更为理想。

Objective To observe the clinical effect of pulmonary surfactant( PS) combined with nasal continuous positive airway pressure( NCPAP) and pulmonary surfactant combined with nasal intermittent positive pressureventilation( NIPPV) in the treatment of neonatal respiratory distress syndrome( NRDS),so as to accumulate experience and provide reference for the optimization of NRDS treatment. Methods Total 122 children of NRDS in our hospital from July 2016 to December 2017 were selected and randomly divided into group PS combined with NCPAP and PS combined with NIPPV group,each group was treated with 61 cases,blood p H,arterial partial pressure of oxygen( PaO2),positive end expiratory pressure( PEEP),partial pressure of carbon dioxide( PaCO2),inhaled oxygen concentration( FiO2),the incidence of complications,such as air leakage and nasal injury,were compared between the two groups,and the statistical analysis was carried out. Results Comparison of different stages in the group,there were significant differences on 24 h about the two groups after treatment with pH,PaO2,PEEP,PaCO2,FiO2 before treatment( all P < 0. 05). Comparing between the two groups,there were significant differences about p H,PaO2,PEEP,PaCO2,FiO2 on 24 h,and the incidence of complications in the PS combined NIPPV group was lower than that in the PS combined NCPAP group. Conclusion PS combined with NIPPV and NCPAP can help to improve the arterial blood gas related indexes of children with NRDS,and can effectively reduce the incidence of complications. In comparison,the clinical efficacy of PS combined with NIPPV is more ideal.