珂立苏联合经鼻间歇性正压通气(NIPPV)治疗新生儿呼吸窘迫综合征46例临床分析

Effect of Calsurf Combined with Nasal Intermittent Positive Pressure Ventilation(NIPPV) in 46 Neonates with Respiratory Distress Syndrome(NRDS):Clinical Analysis

目的:研究珂立苏(肺表面活性物质)联合经鼻间歇性正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法:选取2010年4月-2012年4月我院NICU收治的符合NRDS诊断标准的患儿46例,将患儿随机分为试验组29例和对照组17例。试验组患儿给予珂立苏联合NIPPV治疗,对照组患儿仅给予NIPPV治疗。比较两者患儿治疗前及治疗后6h、24h、48h呼吸功能参数变化情况、X线胸片评分改变情况及3d内存活率。结果:⑴呼吸功能参数情况:试验组患儿上机时(用药前)及用药后6h、24h、48h后肺顺应性(C值)随通气时间进展而逐渐升高,氧合指数(OI值)、呼吸指数(RI值)及肺泡-动脉氧分压差((A-a)DO2值)均随通气时间进展而逐渐下降。试验组患儿经珂立苏治疗后6h、24h、48h和对照组比较,C值均显著高于对照组(P<0.01),OI值均显著低于对照组(P<0.01),RI值均显著低于对照组(P<0.01),(A-a)DO2值均显著低于对照组(A-a)DO2值。⑵X线胸片变化:试验组患儿上机时(用药前)及用药后6h、24h、48h后X线胸片评分逐渐降低,且用药后6h、24h、48h后每一时间点评分均显著低于对照组(P<0.05)。⑶患儿3d内存活率:试验组患儿存活率96.4%显著高于对照组70.1%(P<0.05)。结论:肺表面活性物质(珂立苏)联合经鼻间歇性正压通气(NIPPV)能明显改善患儿肺通气、换气功能,降低患儿死亡率,治疗新生儿呼吸窘迫综合征临床疗效显著优于单纯应用NIPPV治疗。

Objective： To research the effect of calsurf combined with NIPPV in treating NRDS. Methods： Divided 46 neonates with respiratory distresssyndrome into 2 groups. The 29 neonates in observation group were treated by Calsurf combined with NIPPV while the 17 neonates in control group were treated by merely NIPPV. Calculated the changes of C, OI, RI and （A-a）DO2 during mechanical ventilation.Compared the livability and the manifestation on chest X-ray between the 2 groups. Results： （1）The level of C at 6h, 24h, 48h after treatraentin observation group were significantly higher than control group while the level of OI, RI and （A-a）DO2 in observation were all significantly lower than control group （P〈0.01）. （2）The severity of NRDS on chest X-ray at 6h, 24h, 48h after treatment in observation group all significantly lower than control group （P〈0.01）. （3）The livability in 3days of observation group was 96.4%, significantly higher than control group 70.1% （P〈0.05）. Conclusion： Clasurf combined with NIPPV canObviously improve ventilation and aeration, and remarkably reducemortality. Its clinical effect is significantly better than the treatment of merely N1PPV.