外源性肺表面活性物质联合不同机械通气模式治疗新生儿呼吸窘迫综合征临床研究

Retrospective analysis for 168 cases of neonates respiratory distress syndrome treated by Curosurf combined with different mechanical ventilation mothods

目的对用国产表面活性物质(PS)联合不同机械通气模式治疗168例呼吸窘迫综合征(RDS)患儿状况进行回顾性总结。方法回顾性收集168例RDS患儿临床资料,主要包括一般临床特征、应用PS前后的主要血气指标、呼吸机参数、机械通气模式以及并发症、转归等。结果(1)168例患儿平均胎龄(32.3±3.7)周,平均体重(1730±750)g,男婴明显多于女婴;(2)应用PS不同时点比较显示,RDS患儿所需吸氧浓度(FiO2)随时间逐渐下降(P<0.05),而动脉脉血氧分压/FiO2比值(P/F)和动脉血氧分压/肺泡氧分压值(a/APO2)值则均随时间变化逐渐升高(P<0.05);(3)14.9%患儿使用了气管插管-表面活性物质-拔管使用经鼻持续正压通气技术;其余85.1%患儿接受了气管插管机械通气:仅用常频通气模式治疗77.7%;仅用高频震荡通气模式治疗7.0%;常频与高频间有模式转换2.1%;(4)呼吸机相关性肺炎、肺气漏仍是RDS主要相关并发症,总的院内病死率为10.7%。结论国产PS能较快地改善RDS患儿氧合状况,不同通气模式的运用表明肺保护性通气策略正在为越来越多的临床医生所接受。

Objective To summarize our experience in the treatment of respiratory distress syndrome （RDS） in neonates by. Calsurf combined with mechanical ventilation （MV）. Methods The study involved RDS patients who admitted to neonatal intensive care unit （NICU） and received Curosurf and MV treatment. The data were retrospectively collected from the patients＇cases in a standard form,which included general clinical characteristics,mechanical ventilation modes,complications,outcome,and so on. The therapeutic effect of Calsurf was evaluated,and blood gas and ventilator settings were recorded at 0,1,12,72 hours after treatment with Curosurf. Results （1）Mean （SD） gestational age （GA） of the neonates was （32.3±3.7） weeks,and 88.7% of them was preterm （GA 37 weeks）. Mean birth weight （BW） was （1 730±750） grams,and 87.5% of them had BW 2 500 grams. The male/female ratio was 4.6∶1（138/30）. （2）At 0,1,12 and 72 hours after treatment with Calsurf,FiO2 of RDS patients was 0.51±0.11,0.32±0.1,0.28±0.08 and 0.26±0.09,respectively. There was a significant decrease in FiO2,however,there was a increase in PiO2/FiO2 and a/APO2,which were observed at different time points,especially between 0 and 1 hour （P〈0.05）. （3）Different ventilation modes were applied to these patients. In 14.9% （25/168） of these infants,surfactant was administered during a brief intubation followed by immediate extubation （Intubation sur factant extubation）. The surfactant therapy was successfully given only during NCPAP without intubation ventilation in these infants. The conventional mechanical ventilation （CMV）,high frequency oscillation ventilation （HFOV） and CMV＋HFOV were 77.7%,7.0% and 2.1% respectively in the other 143 infants. （4）The two main complications were ventilation related pneumonia and pneumothorax. The total mortality in hospital was 10.7%. Conclusion The Calsurf can quickly improve oxygenation status in patients with RDS. The clinicians are using more and more new therapy methods to rescue RDS patients. These data provide possibility for future studies in the improvement of respiratory care in Tertiary level NICUs.