早期应用泡式鼻持续气道正压通气8cmH_2O和5cmH_2O联合肺表面活性物质防治新生儿呼吸窘迫综合征的临床研究

A comparative study on early applying of B-NCPAP 8 cmH_2O with PS Plus B-NCPAP 5 cmH_2O in neonatal respiratory distress syndrome

目的探讨早期应用泡式鼻持续气道正压通气(B-NCPAP)8cmH2O(1cmH2O=0.098kPa)与肺表面活性物质(PS)+B-NCPAP 5cmH2O防治NRDS的疗效差异。方法B-NCPAP 8组选取2007年4月30日至2008年8月30日在中山大学附属第三医院分娩且生后30min内收入新生儿病房的早产儿,胎龄27～37周、羊水泡沫实验(-)～(+),生后30min内应用B-NCPAP 8cmH2O,分为B-NCPAP 8预防(治疗前未出现呼吸窘迫)和B-NCPAP 8治疗亚组(治疗前出现呼吸窘迫,胸部X线检查提示存在不同程度NRDS改变)。PS+B-NCPAP 5组选取为胎龄27～37周、羊水泡沫实验(-)～(+)的早产儿,生后6h内气管内注入PS并给予B-NCPAP 5cmH2O,分为PS+B-NCPAP 5预防及PS+B-NCPAP 5治疗亚组。结果研究期间,B-NCPAP 8预防和治疗亚组分别纳入48和25例;PS+B-NCPAP 5预防和治疗亚组分别纳入36和22例。B-NCPAP 8预防亚组41/48例(85.4%)未出现呼吸窘迫;7例在应用B-NCPAP 4～6h后出现呼吸窘迫,其中5例为轻度NRDS,继续治疗8h后症状逐渐改善,2例为重度NRDS,在生后8～10h行气管插管注入PS并改用机械通气后存活;应用成功率为95.8%(46/48例)。PS+B-NCPAP 5预防亚组32/36例(88.9%)未出现呼吸窘迫;4例在应用B-NCPAP 4～6h后出现呼吸窘迫,其中3例为轻度NRDS,继续治疗后症状逐渐改善,应用成功率为97.2%(35/36例);1/36例(2.8%)为中度NRDS,改用机械通气后死亡。B-NCPAP 8治疗亚组24/25例(96.0%)治疗2h后血气分析指标改善,1例改用机械通气。PS+B-NCPAP 5治疗亚组18/22例(81.8%)治疗8h后临床症状及血气指标均改善,1/22例(4.5%)死亡。B-NCPAP 8与PS+B-NCPAP 5预防及治疗亚组在防治NRDS的疗效上差异无统计学意义,但B-NCPAP 8预防及治疗亚组的肺部感染发生率、住院时间及住院费用较低(P均<0.05)。结论早期应用B-NCPAP 8cmH2O与PS+B-NCPAP 5cmH2O预防及治疗NRDS的疗效相近,但前者能减少肺部并发症发生,缩短住院时间,减少住院费用。

Objective To determine whether early applying of B-NCPAP （with PEEP 8cm H2O ） or PS plus B-NCPAP （with PEEP 5 cm H2O ） can provide better effects in prophylaxis and treatment of neonatal respiratory distress syndrome. Methods B-NCPAP 8 group ：73 neonates aged 0.5 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving B-NCPAP（ starting at a pressure of 8 cmH2O with binasal prongs）. B-NCPAP 8 group was divided into 2 subgroups： 48 neonates in prevention subgroup（ B-NCPAP 8 P）, received B-NCPAP before development of NRDS, 25 in treatment subgroup（ B-NCPAP 8 T）, received B-NCPAP after development of NRDS. PS ＋ B-NCPAP 5 group ：58 neonates aged 6 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving PS plus B-NCPAP（ starting at a pressure of 5 cmH2O with binasal prongs ）. PS ＋ B-NCPAP 5 group was divided into 2 subgroups： 36 neonates in prophylactic subgroup （PS ＋ B-NCPAP 5 P）, received PS before development of NRDS, 22 in treatment subgroup （ PS ＋ B-NCPAP 5 T）, received PS after development of NRDS. Results In 48 B-NCPAP 8 P infants ,41 infants were improved, the prophylactic achievement ratio was 85.4%. 7 infants got dyspnea after 4 -6 h of B-NCPAP,5 of them finally were improved, while 2 infants needed PS and mechanical ventilation. In 36 PS ＋ B-NCPAP 5 P infants ,32 infants were improved, the prophylactic achievement pencentage was 88.9 % , 4 infants got dyspnea , 3 of them finally were improved, while 1 infant needed PS and mechanical ventilation and 1 infant finally died of NRDS, the mortality rate was 2.7%. In 25 B-NCPAP C infants ,24 of them were improved, the curative ratio was 96% , only one of them got dyspnea after 4 -6 h of B-NCPAP and needed be given PS and mechanical ventilation after 24 h treatment of B-NCPAP. In 22 PS ＋ B-NCPAP 5 C infants , 18 of them were improved, the curative ratio was 81.8% ,one infant died, the mortality rate was 4.5%. The total time of supplemental oxygen administration, assisted ventilation, hospitalization and cost of hospitalization of B-NCPAP 8 group was shortened compared with PS ＋ B-NCPAP 5 group either in prevention or in treatment . Conclusions Early B-NCPAP （ with PEEP 8 cmH2O ） applying provided an equivalent effect compared with PS plus B-NCPAP （ with PEEP 5 cmH2O ） in prophylaxis and treatment of neonatal respiratory distress syndrome.