NIPPV模式通气联合PS替代疗法治疗早产儿呼吸窘迫综合征的疗效及支气管肺部发育的影响

Therapeutic Effect of NIPPV Mode Ventilation Combined with PS Replacement Therapy on Respiratory Distress Syndromes in Premature Infants and Its Effect on Bronchopulmonary Development

目的:探讨经鼻间歇正压通气(NIPPV)模式通气联合肺表面活性物质(PS)替代疗法治疗早产儿呼吸窘迫综合征(RDS)的疗效及对患儿支气管肺部发育的影响.方法:将2015年5月—2017年5月我院收治的150例RDS早产患儿(胎龄28~32周)按随机数字表法分为两组,各75例.联合组接受NIPPV模式通气+PS替代治疗,PS组接受PS替代治疗,比较两组治疗效果和支气管肺不发育等情况.结果:治疗1,6,12,24 h后,动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)和pH均呈升高趋势,动脉二氧化碳分压(PaCO2)均呈下降趋势,且联合组上述指标改善幅度均大于PS组,差异有统计学意义(P<0.05);联合组治疗成功率显著高于PS组,差异有统计学意义(P<0.05);联合组无创通气治疗失败后行气管插管通气治疗率低于PS组,平均住院时间和平均呼吸机使用时间均短于PS组,差异有统计学意义(P<0.05);联合组支气管肺发育不良(BPD)发生率明显低于PS组,差异有统计学意义(P<0.05);联合组并发症总发生率显著低于PS组,差异有统计学意义(P<0.05).结论:NIPPV 模式通气联合 PS 替代疗法治疗早产儿呼吸窘迫综合征的疗效显著,可提高无创呼吸治疗成功率,降低 BPD 和其他并发症发生率,改善预后,缩短患儿住院时间.

Objective:To investigate the therapeutic effect of nasal intermittent positive pressure ventilation(NIPPV)mode ventilation combined with pulmonary surfactant(PS)replacement therapy on respiratory distress syndromes(RDS)in premature infants and its effect on bronchopulmonary development in the children.Methods:150 premature children with RDS(fetal age 28~32 weeks)admitted to our hospital from May 2015 to May 2017 were randomly divided into two groups(a combined group and a PS group),75 cases each.The children in the combined group received NIPPV mode ventilation and PS replacement therapy,and the children in the PS group received PS replacement therapy.The therapeutic effect,bronchopulmonary aplasia and so on were compared between the two groups.Results:After 1,6,12 and 24 h of treatment,the arterial partial pressure of oxygen(PaO2),arterial oxygen saturation(SaO2)and pH showed an increasing trend,while the arterial partial pressure of carbon dioxide(PaCO2)showed a decreasing trend,and the improvement of the above indexes in the combined group was greater than that in the PS group,with statistically significant differences(P<0.05).The success rate of the treatment in the combined group was significantly higher than that in the PS group,and the difference was statistically significant(P<0.05).The treatment rate of tracheal intubation ventilation after failure of non-invasive ventilation in the combined group was lower than that in the PS group,and the average hospitalization time and the average ventilator use time were shorter than those in the PS group,with statistically significant differences(P<0.05).The incidence of bronchopulnonary dysplasia(BPD)in the combined group was significantly lower than that in the PS group,and the difference was statistically significant(P<0.05)).The total incidence of complications in the combined group was significantly lower than that in the PS group,and the difference was statistically significant(P<0.05).Conclusion:NIPPV mode ventilation combined with PS replacement therapy is significantly effective in the treatment of respiratory distress syndromes in the premature infants,which can improve the success rate of non-invasive respiratory therapy,reduce the incidence of BPD and other complications,improve the prognosis of the diseases and shorten the hospitalization time of the children.