产房或手术室内应用固尔苏联合NCPAP治疗NRDS的疗效

Effects of curosurf and nasal continuous positive airway pressure on neonatal respiratory distress syndrome in delivery rooms or operating rooms

目的:通过对比不同时段应用肺表面活性物质(PS,商品名:固尔苏)联合经鼻持续气道正压通气(NCPAP)治疗胎龄≤32周新生儿呼吸窘迫综合征(NRDS)的疗效差异。方法:将2011年5月~2013年4月高州市人民医院新生儿科收治的胎龄≤32周、确诊为NRDS的67例早产儿,按照PS的给予时间不同进行分组,观察组31例为在本院产科出生的早产儿,出生后1 h内在本院产房或手术室内给药;对照组36例为出生后6 h内由外院转诊我院新生儿科的早产儿,转至新生儿病房后即在新生儿病房内给药。两组患儿给药后均接NCPAP辅助呼吸,比较两组患儿用药后的临床症状、胸片、动脉血气等的变化程度,以及NCPAP辅助通气时间、上机率、病死率、并发症等方面的差异。结果:观察组临床症状、胸片及动脉血气得到较快改善,与对照组差异有统计学意义;观察组NCPAP辅助通气时间相对较短,上机率少,但差异无统计学意义;两组患儿病死率及并发症的发生率差异无统计学意义。结论:产房或手术室内极早期应用固尔苏可明显改善患儿呼吸功能,为NRDS患儿的后续治疗提供有利前提。

Objective:To compare the differences in the efficacy of pulmonary surfactant(PS) in combination with nasal continuous positive airway pressure(NCPAP),when administered at different time points,on neonatal respiratory distress syndrome(NRDS) in neonates aged 32 weeks or less.Methods:Between May 2011 and April 2013,we recruited 67 neonates with NRDS aged 32 weeks or less,from the department of neonatology,Gaozhou People's Hospital.Neonates were assigned according to the time of PS administration.Observation group(n = 31) received PS within the first hour after birth in the delivery rooms or operating rooms.Control group(n = 36) received PS in 1-6 h after birth in the neonatal ward,after referral from other hospitals.NCPAP was implemented after the administration of PS.The changes in clinical manifestation,arterial blood gas,chest X-ray with time,the duration of NCPAP and the rates of mechanical ventilation and mortality and complications were compared.Results:The clinical manifestation,arterial blood gas and chest X-ray were rapidly improved in the observation group compared with the control group(all P<0.05).The observation group was associated with a numerically but not statistically shorter duration of NCPAP,a lower rate of mechanical ventilation compared with control group(both P>0.05).The between-group differences in mortality rate and complications were unremarkable(both P>0.05).Conclusion:The early administration of PS in the delivery rooms or operating rooms markedly improves the respiratory function and confers promising outcomes for the subsequent treatment of NRDS.