双水平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研究

Clinical Study of Bi-level Positive Pressure Ventilation Combined with Pulmonary Surfactant in the Treatment of Neonatal Respiratory Distress Syndrome

目的探析双水平正压通气(DuoPAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)临床疗效。方法方便选取该院2016年4月—2018年7月接收的64例胎龄在29~33周伴有重度新生儿呼吸窘迫综合征,分娩后6h内需要采取无创呼吸机支持的早产儿纳入至该次研究中,随机分为两组,每组32例,对照组行经鼻持续气道正压通气(nCPAP)治疗,研究组则采取DuoPAP治疗,对比两组治疗效果。结果在治疗总有效率方面,对照组与研究组分别是75.00%和94.12%,研究组较对照组更高,差异有统计学意义(χ^2=4.267;P=0.039);在PaCO2、PaO2及pH方面,研究组与对照组治疗前均无统计学意义(P>0.05);治疗后1、12、24h和48h均较对照组更优,差异有统计学意义(t=4.265,4.091,4.427,4.307,4.711,4.851,4.231,4.711,4.851,4.171,4.247,4.138,P<0.05)。结论新生儿呼吸窘迫综合征治疗期间,联合使用肺表面活性物质和双水平正压通气治疗方法,有助于改善患儿血气指标,促进治疗效果的提高,在临床中值得不断采纳和推广。

Objective To analyze the clinical efficacy of dual-level positive pressure ventilation (DuoPAP) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods 64 cases of gestational age received from April 2016 to July 2018 in our hospital were convenient selected and accompanied by severe neonatal respiratory distress syndrome from 29 weeks to 33 weeks. Premature infants who needed noninvasive ventilator support within 6 hours after delivery were included. To this study, they were randomly divided into two groups, 32 patients in each group. The control group received nasal continuous positive airway pressure (nCPAP) treatment, while the study group received DuoPAP treatment. Results In the total effective rate of treatment, the control group and the study group were 75.00% and 94.12%, respectively. The study group was higher than the control group, the difference was statistically significant (χ^2=4.267;P=0.039);at PaCO2, PaO2 and pH. In terms, there was no significant difference between the study group and the control group before treatment (P>0.05). The 1, 12, 24 h and 48 h after treatment were better than the control group, the difference was statistically significant (t=4.265, 4.091, 4.427, 4.307, 4.711, 4.851, 4.231, 4.711, 4.851, 4.171, 4.247, 4.138, P<0.05). Conclusion During the treatment of neonatal respiratory distress syndrome, the combination of pulmonary surfactant and bi-level positive pressure ventilation can improve the blood gas index and improve the therapeutic effect. It is worthy of continuous adoption and promotion in clinical practice.