INSURE技术与传统机械通气治疗新生儿呼吸窘迫综合征的临床疗效对比

Comparison of clinical effects of INSURE technique and traditional mechanical ventilation in treatment of neonatal respiratory distress syndrome

目的探讨气管插管-肺表面活性物质-拔管(INSURE)技术与传统机械通气治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法选取2015年1月-2016年12月阜阳市人民医院新生儿病房收治的有呼吸困难且需要呼吸支持的NRDS患儿145例,按照随机数字表法将其分为观察组75例与对照组70例。观察组患儿生后尽快予以气管插管、气管内滴入肺表面活性物质、拔管后经鼻持续气道正压通气。对照组患儿生后予以气管插管、气管内滴入肺表面活性物质、不拔除气管导管直接连接呼吸机辅助通气。比较两组患儿治疗前后血气分析指标PaO_2、PaCO_2、PaO_2/FiO_2和FiO_2变化、并发症发生情况及用氧时间、治愈情况、住院时间等。结果两组治疗后PaO_2增加而PaCO_2降低(均P<0.05);观察组治疗后PaO_2高于对照组而PaCO_2低于对照组(均P<0.05)。两组治疗后PaO_2/FiO_2增加而FiO_2降低(均P<0.05);观察组治疗后PaO_2/FiO_2高于对照组而FiO_2低于对照组(均P<0.05)。观察组并发症发生率低于对照组,两组比较,差异有统计学意义(P<0.05)。观察组治愈率高于对照组且住院时间和用氧时间短于对照组(P<0.05)。结论相比于传统机械通气,INSURE术治疗NRDS临床效果显著。

Objective To explore the clinical effects of INSURE technique and traditional mechanical ventilation in treatment of neonatal respiratory distress syndrome(NRDS）. Methods From January 2015 to December 2016,145 children with dyspnea and respiratory support were selected from neonatal ward of Fuyang Municipal People’s Hospital in Anhui province. According to random number table,they were divided into observation group(75 cases） and control group(70 cases）. The patients in observation group were given tracheal intubation,intratracheal dripping of pulmonary surfactant,and nasal continuous positive airway pressure after extubation. In control group,tracheal intubation,intratracheal dripping of pulmonary surfactant,and tracheal intubation directly connected to ventilator assisted ventilation after birth were given. The changes of blood gas analysis indexes(PaO2,PaCO2,PaO2/FiO2 and FiO2）,the incidence rates of complications,curative effects,and hospitalization time before and after treatment were compared between the two groups. Results After treatment,PaO2 levels increased and PaCO2 levels decreased in the two groups(P〈0. 05）. After treatment,PaO2 level in observation group was statistically significantly higher than that in control group,while PaCO2 level in observation group was statistically significantly lower than that in control group(P〈 0. 05）. After treatment,PaO2/FiO2 increased and FiO2 levels decreased in the two groups(P 〈 0. 05）. After treatment,PaO2/FiO2 ratio in observation group was statistically significantly higher than that in control group,while FiO2 level in observation group was statistically significantly lower than that in control group(P 〈 0. 05）. The incidence rate of complications in observation group was statistically significantly lower than that in control group(P〈 0. 05）. The cure rate in observation group was statistically significantly higher than that in control group,while hospitalization time and oxygen consumption time in observation group were statistically significantly shorter than those in control group(P〈0. 05）. Conclusion Compared with traditional mechanical ventilation,INSURE technique has a significant clinical effect in treatment of NRDS.