经鼻持续气道正压通气时机对新生儿呼吸窘迫综合征预后的影响

Role of opportunity of nasal continuous positive airway pressure on the prognosis of neonatal respiratory distress syndrome

目的探究经鼻持续气道正压通气时机对新生儿呼吸窘迫综合征患儿预后的影响。方法纳入郑州大学第五附属医院2016年10月至2018年10月收治的120例呼吸窘迫综合征新生儿为研究对象,根据实施经鼻持续气道正压通气的时机分为早期组(出生8 h内)及晚期组(出生8~12 h内),每组60例。比较两组患儿治疗后24 h的临床疗效,记录患儿治疗前、治疗后24 h血气分析指标[二氧化碳分压(PaCO2)、血氧分压(PaCO2)、酸碱度(pH)]、持续气道正压参数结果[吸入氧浓度(FiO2)、呼气末正压(PEEP)]及治疗后24 h肺功能指标[呼吸频率(RR)、潮气呼气峰流量(PEF)、达峰时间(TPEF)、达峰容积比(VPEF/VE)]。结果治疗后24 h,早期组治疗总有效率(96.67%,58/60)高于晚期组(85.00%,51/60),P<0.05。两组患儿PaCO2均低于治疗前(P均<0.05),PaCO2、pH均高于治疗前(P均<0.05);且早期组PaCO2低于晚期组,PaCO2、pH高于晚期组(P<0.05)。两组患儿FiO2、PEEP均较治疗前降低(P均<0.05),治疗后早期组PEEP低于晚期组(P<0.05),但两组FiO2比较差异未见统计学意义(P>0.05)。两组患儿PEF、VPEF/VE比较差异未见统计学意义(P>0.05);早期组RR大于晚期组,TREF小于晚期组(P<0.05)。结论早期应用经鼻持续气道正压通气可提高新生儿呼吸窘迫综合征治疗效果,改善患儿肺通气功能。

Objective To investigate the Role of opportunity of nasal continuous positive airway pressure on the prognosis of neonatal respiratory distress syndrome.Methods A total of 120 neonates with respiratory distress syndrome in the Fifth Affiliated Hospital of Zhengzhou University from October 2016 to October 2018 were included as study subjects.According to the timings of nasal continuous positive airway pressure,the neonates were divided into early stage group(within 8 h after birth)and advanced stage group(within 8 h to 12 h after birth),with 60 cases in each group.The clinical efficacy was compared between the two groups after 24 h of treatment.The blood gas analysis indexes,such as partial pressure of carbon dioxide(PaCO2),partial pressure of blood oxygen(PaCO2),pH,and continuous positive airway pressure parameters,such as fraction of inspired oxygen(FiO2),positive end expiratory pressure(PEEP)before and 24 h after treatment of the two groups were recorded.The lung function indexes,such as respiration rate(RR),tidal peak expiratory flow(PEF),time to peak expiratory flow(TPEF),peak volume ratio(VPEF/VE)24 h after treatment were recorded in the two groups.Results After 24 h of treatment,the total effective rate of treatment in early stage group(96.67%,58/60)was significantly higher than that in advanced stage group(85.00%,51/60),P<0.05.The PaCO2 in the two groups was significantly lower than that before treatment(P all<0.05),while the PaCO2 and pH were higher than those before treatment(P all<0.05).The PaCO2 in early stage group was lower than that in advanced stage group,while the PaCO2 and pH were higher than those in advanced stage group after treatment(P all<0.05).The FiO2 and PEEP in the two groups were significantly decreased compared with those before treatment(P all<0.05),and the PEEP in early stage group after treatment was lower than that in advanced stage group(P<0.05),but there was no significant difference in FiO2 between the two groups(P>0.05).There were no significant differences in the PEF and VPEF/VE between the two groups(P>0.05),and the RR in early stage group was larger than that in advanced stage group,and the TREF was smaller than that in advanced stage group(P all<0.05).Conclusions Early application of nasal continuous positive airway pressure can improve the treatment effects of neonatal respiratory distress syndrome and promote pulmonary ventilation function of children.