肺表面活性物质联合机械通气与持续正压通气治疗新生儿肺透明膜病的疗效比较

Comparison study on curative effects of pulmonary surfactant combined with NCPAP and MCV on treatment of hyanline membrane disease

目的观察肺表面活性物质联合经鼻塞持续正压通气（NCPAP）与机械通气（MCV）对新生儿肺透明膜病（HMD）的治疗效果，并比较其呼吸机相关性肺炎等并发症的发生情况。方法将2009年1月-2011年3月在厚街医院确诊为HMD的25例患儿随机分为MCV组（13例）和NCPAP组（12例）两组均应用肺表面活性物质（Ps）治疗，MCV组采用MEQUET呼吸机机械通气，NCPAP组采用德国Stephan无创呼吸机，观察两组方法治疗HDM的疗效情况。结果两组应用Ps前及6h后的Pa02、PaCO2、PH、SaO2均有显著改善（P〈0．051，Fi02显著下降，但两组患儿Pa02、PaC02、PH、Sa02、FiO2比较差异均无显著性（P〉0．05）两组患儿通气时间、氧疗时间、住院天数、抢救成功率、治愈率比较差异均无显著性（P〉0．05）;NCPAP组呼吸机相关性肺炎发生率（0例）低于MCV组（5例），差异有显著性（p〈0．05）。结论PS＋NCPAP与PS＋MCV治疗HMD患儿均有疗效且疗效相似，但PS＋NCPAP的呼吸机相关性肺炎发生率低，并且有无创、操作简便的优点，对于治疗HMD患儿应首选。

Objective To observe and compare the effect of pulmonary surfactant combined with nasol continous positive airway pressure（NCPAP） and machine ventilation（MCV） on treatment of severe hyaline membrane disease （HMD） in neonates. Methods 25 preterm newborns with llI- 1V degree HMD were randomly allocated into NCPAP and MCV groups ： 12 cases with hyeline membrane disease to NCPAP who were given pulmonary surfactant （Curosurf 100-150 mg/ kg＂ dose） ] by intratracheal instillation, regarded as NCPAP group. 13 cases were treated with machine ventilation combined with pulmonary surfactant served as control group. Blood gas analysis, FiO2, duration of ventilation and length of stay in NICU, complications, hospitalization were compared between two groups. Results Blood gases improved at the time of 6 hours after treatment in the two groups（P 〈 0.05）. There were no significant difference between them（P 〉 0.05）. There were no significant difference between duration of ventilation, duration of oxygen therapy , duration of hospitalization, rescue success rate and cure rate in the two groups （P〉 O.05）.The babies in NCPAP group had less incidence rate of pulmonary infection （P〈 0.05） .Conclusion Preterm infants with hyaline membrane disease can achieve the improved prognosis by being managed with NCPAP combined with pulmonary surfactant, which has the advantages of less pulmonary infection than MCV.