肺表面活性物质联合nHFOV治疗对呼吸窘迫综合征早产儿动脉血气指标的影响

Effects of pulmonary surfactant combined with noninvasive high frequency oscillatory ventilation for treating preterm infants with neonatal respiratory distress syndrome on the arterial blood gas indexes of the premature infants

目的:探讨肺表面活性物质(PS)联合经鼻无创高频通气(nHFOV)治疗对呼吸窘迫综合征(NRDS)早产儿动脉血气指标的影响。方法:选取2017年8月-2019年8月本院收治的106例NRDS早产儿,随机分为两组各53例,对照组给予PS联合经鼻持续气道正压通气(n CPAP)治疗,观察组给予PS联合nHFOV治疗,对比两组通气1h、12h、24h及48h时动脉血气指标,治疗效果和并发症情况。结果:观察组通气24h时动脉血氧分压(PaO2)(88.92±12.52 mmHg)、PaO2/吸入氧浓度(254.61±40.02)高于对照组(75.15±14.26 mmHg、229.26±39.23),通气12h、24h及48h时的二氧化碳分压值低于对照组,撤机成功率(86.8%)高于对照组(66.0%)(均P<0.05);两组撤机失败原因、无创呼吸支持时间、有创呼吸支持时间、总用氧时间及总住院时间对比无差异,腹胀、气漏综合征、坏死性小肠结肠炎、支气管肺发育不良、脑室内出血、早产儿视网膜病变的并发症发生率及死亡率无差异(均P>0.05)。结论:PS联合nHFOV治疗能明显改善NRDS早产儿的氧合作用,提高撤机率且未增加治疗并发症,应用效果优于n CPAP治疗。

Objective:To investigate the effects of pulmonary surfactant(PS)combined with noninvasive high frequency oscillatory ventilation(nHFOV)for treating preterm infants with neonatal respiratory distress syndrome(NRDS)on the arterial blood gas indexes of the premature infants.Methods:106 preterm infants with NRDS were selected and were randomly divided into control group and observation group(53 cases in each group)between August 2017 and August 2019.The infants in the control group were given PS combined with nasal continuous positive airway pressure(nCPAP),and the infants in the observation group were given PS combined with nHFOV.Arterial blood gas indexes at 1h,12h,24h,and 48h after ventilation,the treatment effect,and complications rate of the infants were compared between the two groups.Results:The values of PaO2(88.92±12.52mmHg)and inhaled oxygen concentration(254.61±40.02)of the infants in the observation group at 24h after ventilation were significant higher than those(75.15±14.26mmHg and 229.26±39.23)of the infants in the control group.The PCO2 values of the infants in the observation group at 12h,24h and 48h after ventilation were significant lower than those of the infants in the control group.The success rate of withdrawal(86.8%)of the infants in the observation group was significant higher than that(66.0%)of the infants in the control group(all P<0.05).There were no statistically significant differences in the failure reason for withdraw of respirator,noninvasive respiratory support time,invasive respiratory support time,total oxygen use time,and total hospital stay,the incidences of complications,such as abdominal distension,air leak syndrome,necrotizing enterocolitis,bronchopulmonary dysplasia,intraventricular hemorrhage,and retinopathy of prematurity,and mortality rate between the two groups(P>0.05).Conclusion:PS combined with nHFOV can significantly improve the oxygenation of preterm infants with NRDS,can increase the rate of respirator withdraw without increasing the complications rate,which is better than that of nCPAP therapy.