经鼻无创同步间歇指令通气在早产儿呼吸窘迫综合征初始治疗中的应用分析

An analysis on application of nasal non-invasive synchronized intermit-tent mandatory ventilation as a primary treatment in premature infants with respiratory distress syndrome

目的探讨经鼻无创同步间歇指令通气（nSIMV）在早产儿呼吸窘迫综合征（RDS）初始治疗中的作用和联用珂立苏的最佳时间窗。方法回顾性分析两家医院新生儿重症监护病房2012年9月~2014年8月收治的148例早产儿RDS患者的临床资料,根据是否使用了珂立苏分为n SIMV＋珂立苏组105例和单纯nSIMV组43例;再按使用珂立苏的时间不同,将nSIMV＋珂立苏组分为1~5五个小组,比较其治疗结果。结果 n SIMV＋珂立苏组与单纯nSIMV组比较,初始nSIMV失败、腹胀、新生儿坏死性小肠结肠炎（NEC）、早产儿视网膜病（ROP）、肺炎、败血症、支气管肺发育不良（BPD）的发生率（%）比较,差异有统计学意义（P〈0.05）;但nSIMV治疗2~4 h,再给予珂立苏,血气分析和上述结果发生显著改变,其中初始n SIMV失败、NEC、ROP、BPD的最低发生率分别为23.8%、8.3%、19.0%、8.3%。结论 nSIMV作为早产儿RDS的初始治疗模式,能减少使用有创机械通气和珂立苏,降低RDS并发症的发生率;先使用nSIMV 2~4 h,再给予珂立苏,可显著改善RDS预后,起到更好的疗效。

Objective To explore the effects of nasal non-invasive synchronized intermittent mandatory ventilation （nSIMV） as a primary treatment in premature infants with respiratory distress syndrome（RDS） and to explore the optimal time window of combined application of Calsurf. Methods Retrospective analysis was carried out for the clinical data of 148 premature infants with RDS who were admitted to NICU in the two hospitals from September 2012 to August 2014. They were assigned to nSIMV＋Calsurf group of 105 patients and simple nSIMV group of 43 patients, based on whether Calsurf was applied; nSIMV ＋Calsurf group was assigned to subgroups based on different application time of Calsurf. Curative effects were compared between two groups. Results Compared with simple nSIMV group, incidence rates （%） of primary nSIMV failure, abdominal distention, NEC, ROP, pneumonia, septicemia, and BPD in the nSIMV＋ Calsurf group, and the differences were statistically significant （P〈0.05）; however, calsurf was administered after 2 to 4 hours of the nSIMV treatment, and blood gas analysis and the above results significantly changed. The lowest inci- dence rates of primary nSIMV failure, NEC, ROP, and BPD were 23.8%, 8.3%, 19.0% and 8.3% respectively. Conclu- sion nSIMV, as the primary treatment mode in premature infants with RDS, is able to reduce the application of inva- sive mechanical ventilation and calsurf, and lower the incidence rate of RDS complications; administration of calsurf after 2-4 hours of nSIMV application helps significantly improve the prognosis of RDS and has a better curative effect.