肺表面活性物质联合鼻塞持续气道正压通气治疗新生儿呼吸窘迫综合征疗效观察

Observation on the effect of pulmonary surfactants and nasal continuous positive airway pressure replacement therapy on neonatal respiratory distress syndrome

目的:探讨肺表面活性物质(PS)联合鼻塞持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法:21例NRDS患儿经气管插管给予PS治疗,固尔苏120 mg.kg-1.次-1,PS治疗前后均给予NCPAP支持。观察PS治疗前后患儿临床表现、X线胸片的改变,分析比较PS治疗前后动脉血气分析和NCPAP参数的变化。结果:与应用PS治疗前比较,应用PS后1 h患儿呼吸窘迫症状消失8例(38.1%),明显好转12例(57.1%);24 h X线胸片转正常15例(71.4%),好转4例(19.0%)。与应用PS前比较,应用PS后1 h、6 h、12 h、24 h、48 h动脉血气分析示PaO2、a/APO2明显上升,PaCO2及OI明显下降,差异均有统计学意义(P<0.01);NCPAP的压力及FiO2明显下降,差异均有统计学意义(P<0.01)。21例NRDS患儿经PS联合NCPAP治疗,治愈19例(90.5%),1例改机械通气后治愈,1例放弃治疗后死亡。结论:PS联合NCPAP治疗NRDS疗效显著,可有效减少机械通气率。

Objective： To explore the effect of pulmonary surfactants （PS） and nasal continuous positive airway pressure （NCPAP） replacement therapy on neonatal respiratory distress syndrome （NRDS） . Methods： 21 NRDS infants were given PS by endotracheal intubation, the dose of curosurf was 120 mg/kg per time. All the infants received NCPAP before and after PS therapy. The clinical manifestations and the changes of chest X - ray were observed, the results of arterial blood gas analysis and parameters of NCPAP before and after PS therapy were compared. Results： One hour after administration of PS, respiratory distress of newborn infants was relieved completely in 8 cases （38. 1% ）, and decreased markedly in 12 cases （57. 1% ） . 24 hours later, the chest X-ray turned to normal in 15 cases （71.4%） and improvement in 4 cases （19. 0% ） . 1 hour, 6 hours, 12 hours, 24 hours and 48 hours after administration of PS, arterial blood gas analysis showed PaO2 and a/APO2 increased rapidly, PaCO2 and OI decreased significantly. There was significant difference before and after treatment （P 〈 0.01 ） . The pressure and FiO2 of NCPAP decreased significantly （ P 〈 0.01 ） . 21 cases were treated by PS combined with NCPAP, 19 cases were cured （90. 5% ） , one case needed conventional mechanical ventilation （CMV） and was cured, one case died because of giving up treatment. Conclusion： PS combined with NCPAP are effective in the treatment of NRDS, which can reduce the incidence of CMV.