基层医院应用不同方法经气管插管注入珂立苏治疗新生儿呼吸窘迫综合征效果观察

Observation on the effect of endotracheal intubation of Calsurf in different ways in the treatment of neonatal respiratory distress syndrome in primary hospitals

目的总结基层医院应用传统方法与改良方法经气管插管内注入珂立苏治疗新生儿呼吸窘迫综合征的效果。方法 2013年1月至2016年8月河北省河间市人民医院新生儿科收住院的呼吸窘迫综合征新生儿96例,其中2013年1月至2014年12月收治48例采用传统给药方法,为传统组。2015年1月至2016年8月收治48例采用改良后的方法经气管插管内注入珂立苏,为改良组。比较两组患儿推药过程中经皮血氧饱和度和心率、出现药物反流和皮肤发绀情况及两组病例推药后2h的血气结果、推药后12h内、48h内呼吸困难症状缓解情况及机械通气、总用氧时间、住院时间。结果用药过程中改良组血氧饱和度、心率明显高于传统组,出现面色发绀和药物反流的比例明显低于传统组,差异有统计学意义(P<0.05)。用药后2h改良组PaO_2、pH值高于传统组、PaCO_2低于传统组,差异有统计学意义(P<0.05)。用药后改良组12h、24h呼吸困难症状消失率均高于传统组,差异有统计学意义(P<0.05)。改良组CPAP使用时间、机械通气时间和总吸氧时间均短于传统组,差异有统计学意义(P<0.05);两组住院时间相当,差异无统计学意义(P>0.05)。结论采用改良法经气管插管注入珂立苏治疗新生儿呼吸窘迫综合征对患儿的干扰少,能够减少或避免操作过程中患儿缺氧等不适症状,提高了药物疗效,而且方法简便易行,值得在基层医院的新生儿病房推广。

Objective To summarize the effect of endotracheal intubation of Calsurf in the traditional way or in the modified way in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods A total of 96 neonates were selected as the research subjects, who were admitted to Hejian People＇s Hospital for NRDS between Jan. 2013 to Aug. 2016. Among them,48 neonates were treated with endotracheal intu- bation of Calsurf in the modified way （modified group） and the other 48 received the intuhation in the tradi- tional way （traditional group）. The following data were compared between the two groups： the oxygen sat- uration and heart rate, drug reflux and cynosis of skin during the administration of the medicine, the blood gas result of 2h after treatment, the relief of dyspnea of 12h and 48h after treatment, mechanical ventila- tion, total time of oxygen use, and the length of hospital stay. Results During the treatment,oxygen satura- tion and heart rate in modified group were obviously higher than those in traditional group, while the inci- dence of drug reflux and facial cyanosis was much lower, the difference being statistically significant（P〈 0.05）. Two hours after treatment, PaOz and pH value in modified group were higher than those in tradi- tional group, while PaCOz was lower, and there was significant statistical difference（P〈0.05）. The total relief of dyspnea at 12h and 24h after treatment was better in modified group, and the difference was of sta- tistical significance（P〈0.05）. The time of CPAP and mechanical ventilation and the total time of oxygen use were all shorter in the modified group, the difference being statistical（P〈0.05）. The length of hospital stay had no statistical differenee（P〈0.05）. Conclusion The treatment with endotracheal intubation of Calsurf in the modified way has less interference in the treatment of neonatal respiratory distress syndrome, which can reduce or even avoid anoxia during the treatment and thus improve the effect of treatment; it is easy to per- form and is worth promoting in the neonatal department of primary hospitals.