肺表面活性物质联合BiPAP无创呼吸模式治疗不同胎龄新生儿呼吸窘迫综合征的效果

Effects of pulmonary surfactant combined with BiPAP on neonatal respiratory distress syndrome at different gestational ages

目的探讨肺表面活性物质联合双水平气道正压通气(BiPAP)治疗不同胎龄新生儿呼吸窘迫综合征(NRDS)的效果及对血气指标和机械通气参数的影响。方法根据不同胎龄将山西省运城市中心医院2016年7月至2017年7月收治的120例NRDS患儿分为早期组(28~33周)、中期组(34~37周)与晚期组(>37周),每组40例。三组均应用肺表面活性物质联合BiPAP无创呼吸模式进行治疗,对三组动脉血氧分压(PaO2)、pH值、动脉血二氧化碳分压(PaCO2)、PaO2/吸入氧浓度(FiO2)、呼气末正压(PEEP)、平均气道压力(MAP)、机械通气时间、首次用药时间与用药剂量进行比较。结果①早期组首次用药时间、机械通气时间短于中、晚期组,首次用药剂量大于中、晚期组,差异有统计学意义(P<0.05)。②早期组PEEP高于中、晚期组,MAP低于中、晚期组,差异有统计学意义(P<0.05)。③早期组PaO2、pH值、PaO2/FiO2高于中、晚期组,PaCO2低于中、晚期组,差异有统计学意义(P<0.05)。结论对不同胎龄NRDS患儿给予肺表面活性物质联合BiPAP治疗均可获得显著疗效。

Objective To analyze the effects of pulmonary surfactant combined with bi-level airway positive airway pressure ventilation(BiPAP)on blood gas index and mechanical ventilation parameters of neonatal respiratory distress syndrome(NRDS)at different gestational ages.Methods A total of 120 cases of NRDS children treated in the Central Hospital of Yuncheng from July 2016 to July 2017 were divided into early stage group(28-33 weeks),middle stage group(34-37 weeks)and late stage group(>37 weeks),with 40 cases in each group.The three groups were treated with pulmonary surfactant combined with BiPAP noninvasive respiratory model.Arterial oxygen partial pressure(PaO2),pH value,partial pressure of carbon dioxide(PaCO2),ratio of PaCO2 to fraction of inspired oxygen(FiO2),positive end expiratory pressure(PEEP),mean airway pressure(MAP)and other values in the three groups were retrospectively compared.Results①The time of the first medication and mechanical ventilation in the early stage group were shorter than those in the middle stage group and late stage group,while the dosage of the first medication of early stage group was higher than that in the other two groups,and there were significant differences(P<0.05).②The level of PEEP in the early stage group was higher than that in the middle stage group and late stage groups;the level of MAP in the early group was lower than that in the other two groups,and there were significant differences(P<0.05).③The values of PaO2,pH and PaO2/FiO2 in the early stage group were higher than those in the middle stage group and late stage group;however,the value of PaCO2 was lower than that in the middle stage group and late stage group,there were significant differences(P<0.05).Conclusions For children with NRDS at different gestational ages,pulmonary surfactant combined with BiPAP can achieve significant curative effect.