不同剂量牛肺表面活性剂联合经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床观察

Clinical Observation of Different Doses of Calf Pulmonary Surfactant Combined with Nasal Intermittent Positive Pressure Ventilation in the Treatment of Neonatal Respiratory Distress Syndrome

目的:探讨不同剂量牛肺表面活性剂联合经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及并发症。方法:选取在我院新生儿科治疗的NRDS患儿90例,按随机数字表法分为大剂量组、中剂量组和小剂量组,各30例。3组患儿均给予NIPPV联合牛肺表面活性剂治疗,大剂量组患儿牛肺表面活性剂剂量为100 mg/kg,中剂量组为70 mg/kg,小剂量组为40 mg/kg。观察3组患儿治疗前后血气指标,并比较其治疗情况、住院时间、治疗费用和并发症发生率。结果:治疗前,3组患儿血清p H值、动脉血二氧化碳分压(Pa CO2)、动脉血氧分压(Pa O2)、动脉血氧饱和度(Sa O2)比较,差异均无统计学意义(P>0.05);治疗后,3组患儿上述指标均显著改善,且大剂量组明显优于中剂量组和小剂量组,差异均有统计学意义(P<0.05)。3组患儿辅助通气时间、氧疗时间、痊愈率、治疗费用比较,差异均无统计学意义(P>0.05);大剂量组患儿用药次数和住院时间明显少于或短于中剂量组和小剂量组,差异均有统计学意义(P<0.05)。大剂量组、中剂量组、小剂量组并发症发生率分别为20.0%、23.3%、16.7%,组间比较差异无统计学意义(P>0.05)。结论:牛肺表面活性剂联合NIPPV可有效改善NRDS患儿血气状态,大剂量牛肺表面活性剂可减少患儿住院时间,且不增加治疗费用及并发症发生率。

OBJECTIVE：To explore clinical efficacy and compliance of different doses of calf pulmonary surfactant combined with nasal intermittent positive pressure ventilation （NIPPV） in the treatment of neonatal respiratory distress syndrome （NRDS）. METHODS：90 children diagnosed as NRDS were collected from neonatal department of our hospital,and were divided into high-dose group,middle-dose group and low-dose group by random number table method,with 30 cases in each group. 3 groups received NIPPV combined with calf pulmonary surfactant;the dose of calf pulmonary surfactant in high-dose group,middle-dose group and low-dose group were 100,70,40 mg/kg,respectively. Blood gas indexes,treatment,hospitalization duration,treatment cost,the incidence of compliance were compared among 3 groups. RESULTS：Before treatment,there was no statistical signifi-cance in pH,PaCO2,PaO2,SaO2 among 3 groups（P〉0.05）;after treatment,above indexes of 3 groups were all improved signifi-cantly,and the high-dose group was significantly better than middle-dose group and low-dose group,with statistical significance （P〈0.05）. There was no statistical significance in duration of ventilation,oxygen therapy duration,cure rate and treatment cost among 3 groups（P〉0.05）. Medication times and hospitalization time of high-dose groups were significantly lower or shorter than those of middle-dose group and low-dose group,with statistical significance （P〈0.05）. The rate of complication in high-dose group,middle-dose group and low-dose group were 20.0%,23.3% and 16.7%,respectively,there was no statistical significance （P〉0.05）. CONCLUSIONS：Calf pulmonary surfactant combined with NIPPV could effectively improve the blood gas status of newborn with NRDS. High dose of calf pulmonary surfactant can reduce hospitalization time and doesn’t increase treatment cost and the rate of compliance.