肺表面活性物质和无创SNIPPV防治晚期早产儿持续肺动脉高压的临床研究

Clinical study of pulmonary surfactant and noninvasive SNIPPV in the prevention and treatment of persistent pulmonary hypertension in late preterm infants

目的探讨肺表面活性物质和无创性间歇呼吸道正压通气（无创SNIPPV）防治晚期早产儿（LPI）持续肺动脉高压（PPHN）的疗效。方法回顾性分析2010年1月至2016年1月本院新生儿科收治的LPI中合并呼吸窘迫综合征（NRDS）或胎粪吸入综合征（MAS）的病例126例，根据患儿是否使用肺表面活性物质和无创SNIPPV模式分为治疗组（70例）和对照组（56例），比较两组发生PPHN的比例、机械通气使用率和拔管后再次上机的比例以及平均机械通气时间、高PIP时间、高FiO2时间。结果治疗组发生PPHN的比例（17．14％比41。07％）、机械通气使用率（25．71％比85．71％）和拔管后再次上机率（4．29％比25．00％）均比对照组显著降低，差异有统计学意义（P〈0．05）；而治疗组平均机械通气时间、高PIP时间、高FiO2时间均比对照组缩短，差异有统计学意义（P〈0．05）。结论早期使用肺表面活性物质和SNIPPV治疗LPI的NRDS或MAS，可有利于减少PPHN的发生，降低机械通气使用率和拔管后再次上机率，缩短住院时间，降低死亡率，有利于改善高危LPI的预后。

Objective To explore the prevention and treatment effect of pulmonary surfactant and noninvasive SNIPPV in persistent pulmonary hypertension of late preterm infants （LPI）. Methods A retrospective analysis was carried out on 126 cases of LPI with neonatal respiratory distress syndrome （NRDS） or meconium aspiration syndrome （MAS） admitted to neonatology department of our hospital from January 2010 to January 2016, who were divided into treatment group （70 cases） and control group （56 cases） according to whether the use of pulmonary surfactant and noninvasive SNIPPV model. The rates of PPHN, mechanical ventilation, mechanical ventilation once more after the extubation, the average mechanical ventilation time, high PIP time, and high FiO2 time in the two groups were compared. Results The rates of PPHN, mechanical ventilation, mechanical ventilation once more after the extubation in the treatment group were all lower than those in the control group （17.14% vs. 41.07%, 25.71% vs. 85.71%, 4.29% vs. 25.00%）, with statistically significant differences （P〈0.05）. The average mechanical ventilation time, high PIP time, and high FiO2 time in the treatment group were all shorter than those in the control group, with statistically significant differences （P〈0.05）. Conclusions The early use of pulmonary surfactant and SNIPPV in the treatment of late preterm infants with NRDS or MAS, can help to reduce the occurrence of PPHN, reduce the rates of mechanical ventilation, mechanical ventilation once more after the extubation, shorten hospitalization time, reduce the mortality, is conducive to improve the prognosis of high-risk LPI.