INSURE技术治疗早产儿呼吸窘迫综合征临床观察

Clinical observation of the INSURE technique in treatment of premature infants with respiratory distress syndrome

目的观察气管插管-肺表面活性物质-拔管后使用鼻塞式气道正压通气(Intubate-SurfactantExtubate to CPAP,INSURE)技术在治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的疗效。方法选取2012-07~2016-02该院住院NRDS共58例,其中对照组27例,仅给予经鼻连续气道正压通气(nasal continuous positive airway pressure,NCPAP)治疗;观察组31例,给予INSURE技术治疗,比较两组患儿治疗前、治疗后1 h、4~6 h、24 h、72 h血气分析变化情况、再插管机械通气率(治疗3 d和7 d内)和总辅助通气时间、总用氧时间、住院时间和病死率。结果治疗后1 h、4~6 h时间段血气分析结果显示动脉血酸碱度(p H)、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)改善更快,观察组再插管机械通气率、总辅助通气时间、总用氧时间、总住院时间均低于对照组(P<0.05)。结论 INSURE技术可减少早产NRDS患儿行有创机械通气的比例,缩短用氧时间和住院时间,降低病死率,且安全易操作,值得临床推广。

Objective To investigate the clinical effect of INSURE technique（PS tracheal instillation＋nasal continuous positive airway pressure） on neonatal respiratory distress syndrome（NRDS）.Methods 58 neonates with NRDS in our department were selected from July 2012 to February 2016 and their clinical date were analyzed retrospectively. 27 cases who were treated with nasal continuous positive airway pressure（NCPAP） were collected as the control group and 31 cases who were treated with INSURE were taken as the observation group. The changes of blood gas at 1 h, 4～6 h, 24 h and 72 h after birth, the intubation and mechanical ventilation rate 3 and 7 days after the treatment, the total ventilation time, the total oxygen time, the duration of hospital stay and mortality rate were compared between the two groups.Results Blood gas analysis showed that pH, PaO2 and PaCO2 in 1 h, 4～6 h were improved faster in the observation group than those in the control group（P〈0.05）. The intubation rate, the mechanical ventilation rate, the total ventilation time, the total oxygen time and the hospitalization time of the observation group were significantly lower than those of the control group（P〈0.05）.Conclusion INSURE technique may reduce the mechanical ventilation rate, use of oxygen, hospitalization time and the mortality rate for the neonates with NRDS.