鼻塞式呼吸机间歇指令通气联合肺表面活性物质治疗早产儿肺透明膜病的临床研究

Nasal intermittent mandatory ventilation combined with pulmonary surfactant for the treatment of neonatal hyaline membrane disease

目的观察鼻塞式呼吸机间歇指令通气（NIMV）联合肺表面活性物质（PS）治疗早产儿肺透明膜病（NHMD）的临床疗效，并与常规机械通气及持续气道内正压通气（CPAP）的疗效进行比较。方法NIMV组25例患肺透明膜病的早产儿经气管内滴入PS[100mg／（kg·次）]，然后拔管，予NIMV支持治疗，并与25例常规机械通气及24例CPAP的患儿进行比较，指标包括患儿的临床症状、体征、血气变化及并发症。结果治疗后1h，患儿症状体征明显好转；6、12及24h，3组患儿的血气较治疗前显著改善，NIMV、常规机械通气及CPAP比较，差异无显著性（P〉0．05）。但治疗过程中NIMV组的肺部感染及慢性肺疾病的发生率明显低于机械通气组[（8％vs36％）、（20％vs72％）]，且硒椰组的反复呼吸暂停和二氧化碳潴留的发生率也明显低于常规CPAP组[（8％vs36％）、（20％vs72％）]。结论应用NIMV治疗早产儿肺透明膜病既可减少或避免呼吸机相关性肺炎、慢性肺病等并发症，又可治疗早产儿常发生的反复呼吸暂停，避免二氧化碳潴留。

Objective To evaluate the effect of nasal intermittent mandatory ventilation （NIMV） combined with pulmonary surfactant for the treatment of hyaline membrane disease in premature children and to compare the clinical efficacy with conventional mechanical ventilation and continuous positive airway pressure （CPAP）. Methods Seventy-four babies with severe respiratory syndrome were given curosurf [100 mg/（kg·dose）] ,25 of them were given to NIMV, another 25 were given conventional intermittent mandatory ventilation （IMV）, the last 24 patients were given conventional CPAP. Blood gas analysis parameters and incidences of respiratory complications including respiratory tract infection and chronic lung disease, frequent apnea and carbon dioxide retention, were compared among the three groups. Results After treatment of 1 h, symptoms and signs of the patients markedly improved. All the three groups showed an increase in arterial oxygen partial pressure, but arterial pressure of carbon dioxide and oxygen index decreased significantly by the time of 6,12,24 h after treatment and there were not significantly difference among the three groups. The rates of respiratory infection and chronic lung disease in NIMV group were less than that of conventional IMV group[ （8% vs 36% ）, （20% vs 72% ） ] ,the rates of frequent apnea and carbon dioxide retention in NIMV group were less than that of CPAP group[ （8% vs 36% ）, （20% vs 72% ） ]. Conclusion NIMV combined with pulmonary surfactant is a potentially efficient therapy for hyaline membrane disease in premature infants. NIMV treatment of hyaline membrane disease in premature infants can reduce or avoid ventilation-associated pneumonia, chronic lung disease and other complications, but also efficiently reduce the incidence of frequent apnea and carbon dioxide retention.