经鼻机械通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征疗效观察

Clinical efficacy of nasal mechanical ventilation combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome and prevention of bronchopulmonary dysplasia

目的探讨经鼻机械通气联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及对支气管肺发育不良(BPD)的预防效果。方法回顾性分析2017年2月至2018年2月期间深圳市人民医院新生儿科收治的58例NRDS患儿临床资料,所有患儿均接受经鼻机械通气治疗,根据是否应用PS将患儿分为观察组(接受PS治疗,n=29)和对照组(未接受PS治疗,n=29)。比较两组患儿治疗前后的动脉血酸碱度(pH)、氧分压(PaO2)、二氧化碳分压(PaCO2)水平以及氧疗时间、住院时间和BPD的发生率。结果治疗24 h后,观察组患儿的动脉血pH和PaO2、PaCO2分别为(7.39±0.14)、(78.91±15.3) mmHg、(39.14±2.16) mmHg,明显优于对照组的(7.30±0.12)、(70.14±12.6) mmHg、(44.25±3.32) mmHg,差异均有统计学意义(P<0.05);观察组患儿的氧疗时间、住院时间分别为(9.64±2.02) d、(21.87±4.39) d,均明显短于对照组的(13.24±3.19) d、(26.92±6.26) d,差异均有统计学意义(P<0.05);观察组患儿的BPD发生率为6.90%,略低于对照组的17.20%,但差异无统计学意义(P>0.05)。结论肺表面活性物质治疗新生儿呼吸窘迫综合征可以有效改善患儿的换气及通气功能,减少氧疗及住院时间,临床疗效显著,且可能对降低BPD的发生率有利。

Objective To investigate the clinical efficacy of nasal mechanical ventilation combined with pulmonary surfactant(PS) in the treatment of neonatal respiratory distress syndrome(NRDS) and the prevention of bronchopulmonary dysplasia(BPD). Methods The clinical data of fifty-eight NRDS children treated in Department of Neonatology, Shenzhen People’s Hospital from February 2017 to February 2018 were retrospectively analyzed. All of them received nasal mechanical ventilation. According to whether or not pulmonary surfactant(PS) was used, the children were divided into the observation group(PS treatment, n=29) and control group(no PS treatment, n=29). The arterial pH,PaO2 and PaCO2 were compared before and after treatment. The duration of oxygen therapy, hospital stay and were recorded, and the incidence of BPD was also counted. Results After 24 hours of treatment, the arterial blood pH, PaO2 and PaCO2 in the observation group were 7.39 ± 0.14,(78.91 ± 15.3) mmHg,(39.14 ± 2.16) mmHg, respectively, which were significantly better than corresponding 7.30±0.12,(70.14±12.6) mmHg,(44.25±3.32) mmHg in the control group(all P<0.05). The oxygen therapy time and hospitalization time in the observation group were(9.64 ± 2.02) d,(21.87 ±4.39) d, respectively, which were significantly shorter than corresponding(13.24±3.19) d and(26.92±6.26) d in the control group(all P<0.05). The incidence of BPD in the observation group was 6.90%, which was lower than 17.20% in the control group(P>0.05). Conclusion Pulmonary surfactant therapy for neonatal respiratory distress syndrome can effectively improve ventilator ventilation function, reduce oxygen therapy time and hospitalization time. The clinical effect is significant, it may be beneficial to reduce the incidence of BPD.