肺表面活性物质联合双水平气道正压通气对早产儿呼吸窘迫综合征肺功能及安全性影响

Effects of pulmonary surfactant and bilevel positive airway pressure on lung function and safety of RDS in preterm infants

目的分析肺表面活性物质(PS)联合双水平气道正压通气(BiPAP)对早产儿呼吸窘迫综合征(RDS)肺功能、氧合功能、血清指标及安全性影响。方法选取2017年1月至2019年1月三亚中心医院治疗的RDS早产儿120例,采用随机数字表法分为对照组和观察组,各60例。对照组采用PS联合持续气道正压通气(CPAP)治疗,观察组采用PS联合BiPAP治疗。观察两组肺功能、动脉血气指标、氧交换指标、血清因子与并发症情况。结果观察组每分通气量[(0.53±0.04)L·min^(-1)·kg^(-1)比(0.44±0.05)L·min^(-1)·kg^(-1)]、潮气量[(6.49±1.30)mL/kg比(5.48±1.15)mL/kg]均高于对照组,呼吸频率[(42.51±3.94)次/分钟比(49.32±4.02)次/分钟]低于对照组(P<0.05);两组25%、50%和75%潮气量时呼气流速(TEF25、50、75)、达峰时间比、呼气峰流速(PEF)及达峰容积比差异无统计学意义(P>0.05);治疗后6、12 h观察组pH值、动脉血氧分压(PaO_(2))、PaO_(2)/PAO_(2)、PaO_(2)/FiO_(2)均高于治疗前、对照组,动脉血二氧化碳分压(PaCO_(2))低于治疗前、对照组(P<0.05);治疗后3 d观察组病儿血清高迁移率族蛋白1(HMGB^(-1))、巨噬细胞移动抑制因子^(-1)(MIF^(-1))及Ⅱ型肺泡细胞表面抗原(KL-6)含量均低于治疗前、对照组(P<0.05);观察组病儿住院及氧疗时间低于对照组(P<0.05),两组病儿并发症差异无统计学意义(P>0.05)。结论肺表面活性物质联合BiPAP可有效改善RDS病儿氧合功能与肺功能,且临床应用安全性较高。

Objective To analyze the effects of pulmonary surfactant and bilevel positive airway pressure(BiPAP)on lung function,oxygenation function,serum index and safety of preterm infants with respiratory distress syndrome(RDS).Methods One hundred and twenty cases of premature infants with RDS who were treated in Sanya Central Hospital from January 2017 to January 2019 were randomly assigned into control group and observation group,each group with 60 cases.Control group was treated with pulmonary surfactant(PS)combined with BiPAP combined with continuous positive airway pressure(CPAP),while the observation group was treated with PS combined with BiPAP.The pulmonary function,arterial blood gas indexes,oxygen exchange indexes,serum factors and complications were observed in the two groups.Results The minute ventilation[(0.53±0.04)L·min^(-1)·kg^(-1) vs.(0.44±0.05)L·min^(-1)·kg^(-1)]and tidal volume[(6.49±1.30)mL/kg vs.(5.48±1.15)mL/kg]of the observation group were higher than those of the control group,and the respiratory rate was lower than that of the control group[(42.51±3.94)times/min vs.(49.32±4.02)times/min](P<0.05).There was no significant difference in TEF25%,TEF50%,TEF75%,peak time ratio,peak expiratory flow rate(PEF)and peak volume ratio(P>0.05);the pH value,arterial partial pressure of oxygen(PaO_(2)),PaO_(2)/PAO_(2),PaO_(2)/FiO_(2) of the observation group at 6 h and 12 h after treatment were higher than those before treatment and the control group,and the arterial partial pressure of carbon dioxide(PaCO_(2))was lower than before treatment and the control group(P<0.05).Serum high mobility group protein 1(HMGB^(-1)),macrophage migration inhibitory factor^(-1)(MIF^(-1))and type Ⅱ alveolar cell surface antigen(KL-6)levels of the observation group after 3 days of treatment were lower than those of before treatment and the control group(P<0.05).The hospitalization and oxygen therapy time of children of the observation group was lower than that of the control group(P<0.05),there was no significant difference in complications between the two groups(P>0.05).Conclusion Pulmonary surfactant combined with BiPAP can effectively improve the oxygenation function and lung function in children with RDS,and it is safe in clinical application.