不同时机应用经鼻持续气道正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效观察

Observation on the clinical effects of different starting time of nasal continuous positive airway pressure combined with pulmonary surfactant in treatment of neonatal respiratory distress syndrome

目的探讨不同时机应用经鼻持续气道正压通气(nC PAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效观察。方法选择2013年12月-2015年12月巨野县人民医院收治的96例早产儿进行回顾性分析,早产儿胎龄≤32周,出生后30 min内入院,出现呼吸窘迫征时应用nC PAP联合PS治疗。根据使用PS治疗前应用nC PAP时间分为<2 h组、2~4 h组、>4 h组,观察治疗前后动脉血气变化、治疗3 d与7 d的机械通气率、住院时间、治疗结局、支气管肺发育不良等并发症发病率。结果三组患儿在不同时间应用nC PAP后呼吸窘迫状态均有改善。与用药前比较,2~4 h组血气改善程度相对较明显(P<0.05);2~4 h组治疗3 d需机械通气率最小(P<0.05),三组治疗7 d需机械通气率住院时间及治疗结局比较,差异均无统计学意义(均P>0.05);<2 h组支气管肺发育不良发病率最高,明显髙于2~4 h组(P<0.05),气漏、肺出血等并发症及病死率各组间比较,差异无统计学意义(P>0.05)。结论 NRDS早期给予nC PAP联合PS治疗效果明显,可改善预后,减少机械通气率,降低支气管肺发育不良等并发症发生率,在发病2~4 h应用效果最佳。

Objective To explore the clinical effects of different starting time of nasal continuous positive airway pressure（ nC PAP）combined with pulmonary surfactant（ PS） in treatment of neonatal respiratory distress syndrome（ NRDS）. Methods Ninety-six premature infants（ ≤32 gestational week,admitted to the hospital 30 minutes after birth） treated in the hospital from December 2013 to December2015 were selected and analyzed retrospectively,nC PAP combined with PS was given when NRDS occurred. The infants were divided into 2-hour group,2-4-hour group, 4-hour group according to the application time of nC PAP before PS therapy. The changes of arterial blood-gas,mechanical ventilation rates at 3 and 7 days after treatment,hospitalization time,treatment outcomes,the incidence rates of complications（ such as bronchopulmonary dysplasia） were observed. Results After application of nC PAP,clinical symptoms of NRDS were obviously improved in the three groups. Compared with before treatment,improvement of blood gas in 2-4-hour group was more significant（ P〈0. 05）,mechanical ventilation rate at 3 days after treatment in 2-4-hour group was the lowest（ P〈0. 05）. There was no statistically significant difference in mechanical ventilation rate at 7 days after treatment,hospitalization time,and treatment outcomes among the three groups（ all P〉0. 05）. The incidence rate of bronchopulmonary dysplasia in 〈2-hour group was the highest,which was statistically significantly higher than that in 2-4-hour group（ P〈0. 05）; there was no statistically significant difference in the incidence rates of pulmonary air leak and pneumorrhagia,and case fatality rate among the three groups（ all P〉0. 05）. Conclusion The effect of early nC PAP combined with PS in treatment of NRDS is significant,the method can improve prognosis,reduce mechanical ventilation rate and the incidence rates of complications,such as bronchopulmonary dysplasia,the application effect of nC PAP with starting time within 2-4 hours is the best.