加温湿化高流量鼻导管吸氧结合微创肺表面活性物质治疗新生儿呼吸窘迫综合征的临床效果及对ACTH、sTREM-1水平的影响

Clinical effect of heated humidified high-flow nasal cannula combined with minimally invasive pulmonary surfactant in the treatment of neonatal respiratory distress syndrome and its influences on ACTH and sTREM-1 levels

目的探讨加温湿化高流量鼻导管吸氧(HHHFNC)结合微创肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床效果及对ACTH、sTREM-1水平的影响。方法选取2017年3月至2020年4月收治的100例NRDS患儿为研究对象,根据治疗方案的不同将其分为对照组和观察组,各50例。对照组采用HHHFNC结合常规PS给药,观察组采用HHHFNC结合微创PS给药。比较两组患儿的治疗效果。结果治疗24 h,观察组的PaO_(2)、PaO_(2)/FiO_(2)均高于对照组,PaCO_(2)低于对照组,差异具有统计学意义(P<0.05)。治疗24 h,两组患儿的ACTH、sTREM-1水平均降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。观察组的二次PS应用、气胸、72 h内机械通气、BPD发生率均低于对照组,差异具有统计学意义(P<0.05)。观察组的无创通气时间、氧疗时间、症状缓解时间、住院时间均短于对照组,3 d内呼吸暂停次数少于对照组,差异具有统计学意义(P<0.05)。结论HHHFNC结合微创PS可改善NRDS患儿的通气状态,调节ACTH、sTREM-1水平,缩短治疗时间,利于患儿快速康复,具有较高的安全性,值得推广。

Objective To explore the clinical effect of heated humidified high-flow nasal cannula(HHHFNC)combined with minimally invasive pulmonary surfactant(PS)in the treatment of neonatal respiratory distress syndrome(NRDS)and its influences on ACTH and sTREM-1 levels.Methods A total of 100 children with NRDS treated from March 2017 to April 2020 were selected as the research objects,according to different treatment schemes,the children were divided into control group and observation group,with 50 cases in each group.The control group was treated with HHHFNC combined with conventional PS,and the observation group was treated with HHHFNC combined with minimally invasive PS.The therapeutic of the two groups were compared.Results At 24 h of treatment,PaO_(2) and PaO_(2)/FiO_(2) in the observation group were higher than those in the control group,PaCO_(2) was lower than that in the control group,and the differences were statistically significant(P<0.05).At 24 h of treatment,the levels of ACTH and sTREM-1 in the two groups decreased,and those in the observation group were lower than the control group,the differences were statistically significant(P<0.05).The incidences of secondary PS application,pneumothorax,mechanical ventilation within 72 h and BPD in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The non-invasive ventilation time,oxygen therapy time,symptom relief time and hospital stay in the observation group were shorter than those in the control group,the number of apnea within 3 d was less than that in the control group,and the differences were statistically significant(P<0.05).Conclusion HHHFNC combined with minimally invasive PS can improve the ventilation status of NRDS,regulate the levels of ACTH and sTREM-1,shorten the treatment time,and facilitate the rapid recovery of children,has higher safety,which is worthy of promotion.