清醒气管插管推注PS治疗NRDS的疗效及安全性研究

Efficacy and safety of sober tracheal intubation with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

目的探讨清醒气管插管推注肺表面活性物质(pulmonary surfactant,PS)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的疗效及安全性。方法选取2015年6月至2017年12月本院NICU收治的126例NRDS患儿,采用随机数字法分为观察组和对照组,各63例。观察组患儿采用清醒气管插管推注肺表面活性物质进行治疗,对照组患儿采用利多卡因喉腔表面麻醉下气管插管推注PS进行治疗。观察比较两组患儿的临床疗效、血气及气体交换相关指标、并发症发生率。结果观察组患儿的治疗有效率为92.06%,明显高于对照组的71.43%(P<0.05)。与治疗前比较,治疗后6 h、24 h,两组患儿pH、PaO2、PaO2/FiO2、PaO2/PAO2均明显升高,PaCO2明显降低,差异具有统计学意义(P<0.05);观察组患儿治疗后6 h、24 h pH、PaO2/FiO2、PaO2/PAO2明显高于对照组(P<0.05)。两组患儿脑室内出血、肺间质性气肿、视网膜病、败血症等并发症发生率比较差异无统计学意义。结论清醒气管插管推注肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效确切,可改善患儿换气和通气功能,且安全可靠,值得临床推广应用。

Objective To investigate the efficacy and safety of mandatory tracheal intubation with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome(NRDS).Methods A total of 126 children with NRDS admitted to our hospital from June 2015 to December2017 were randomly divided into observation group and control group,with 63 cases in each group.Patients in the observation group were treated with mandatory tracheal intubation with Pulmonary Surfactant(PS).Patients in the control group were treated with intratracheal intubation with lidocaine for laryngeal surface anesthesia.The clinical efficacy,blood gas and gas exchange related indicators,and the incidence of complications were compared between the two groups.Results The effective rate of the observation group was 92.06%,which was significantly higher than that of the control group 71.43%(P<0.05).Compared with before treatment,the pH,PaO2,PaO2/FiO2,PaO2/PAO2 at 6 h and 24 h after treatment were significantly increased in both groups,the PaCO2 was significantly decreased,and the difference was significant(P<0.05).The pH,PaO2/FiO2 and PaO2/PAO2 of the observation group were significantly higher than those of the control group at 6 h and 24 h after treatment(P<0.05).There was no significant difference in the incidence of intraventricular hemorrhage,interstitial emphysema,retinopathy,sepsis and other complications between the two groups.Conclusion Mandatory endotracheal intubation with pulmonary surfactant for the treatment of neonatal respiratory distress syndrome is effective,safe,reliable and can improve the ventilation and ventilation function of children.So it is worthy of clinical application.