不同时期肺表面活性物质联合NCPAP治疗NRDS的临床疗效及安全性分析

Clinical effect and safety of pulmonary surfactant combined with NCPAP in the treatment of NRDS in different periods

目的探讨不同时期肺表面活性物质(Ps)联合经鼻持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性。方法回顾性分析,选取2020年6月至2021年10月许昌市中心医院收治的93例NRDS患儿资料,依据治疗时间分为早期组51例、晚期组42例。早期组男28例、女23例,胎龄(34.12±1.75)周,于患儿出生后6 h内行Ps联合NCPAP治疗;晚期组男22例、女20例,胎龄(33.48±1.64)周,于患儿出生后6~12 h行Ps联合NCPAP治疗。治疗3 d后比较两组疗效;比较两组治疗1 d及7 d后血气指标变化;比较两组辅助通气时间、临床症状消失时间和住院时间以及住院期间不良反应发生情况。计量资料用t检验,计数资料用χ^(2)检验。结果治疗3 d后,早期组患儿治疗总有效率为96.08%(49/51),高于晚期组83.33%(35/42),差异有统计学意义(χ^(2)=4.280,P=0.039)。治疗1 d后,两组患者动脉血氧分压、酸碱度及氧合指数均有提升,且早期组[(84.28±8.73)mmHg(1 mmHg=0.133 kPa)、(7.16±0.28)、(194.58±17.42)mmHg]均高于晚期组[(75.13±7.89)mmHg、(7.02±0.26)、(176.08±21.05)mmHg],差异均有统计学意义(均P<0.05);两组患者二氧化碳分压均有降低,且早期组低于晚期组[(40.86±3.12)mmHg比(46.03±2.87)mmHg],差异均有统计学意义(均P<0.05)。治疗7 d后,两组患者各项血气指标比较,差异均无统计学意义(均P>0.05)。早期组气促、呼吸困难、三凹征症状消失时间及辅助通气时间分别为(2.38±0.71)d、(2.01±0.51)d、(2.10±0.73)d、(13.85±3.94)d,均短于晚期组的(3.52±1.02)d、(3.27±1.32)d、(3.08±0.94)d、(15.68±4.21)d,差异均有统计学意义(均P<0.05)。两组NRDS患儿不良反应发生率比较,差异无统计学意义(P>0.05)。结论不同时期行Ps联合NCPAP治疗NRDS的安全性无较大差异,但早期行Ps联合NCPAP治疗NRDS的短期疗效更为显著,可加快患儿临床症状缓解及血气指标恢复。

Objective To explore the clinical effect and safety of pulmonary surfactant(Ps)combined with nasal continuous positive airway pressure(NCPAP)in the treatment of neonatal respiratory distress syndrome(NRDS)in different periods.Methods A retrospective analysis was performed on the data of 93 infants with NRDS admitted to Xuchang Central Hospital between June 2020 and October 2021.According to the different treatment time,they were divided into an early group(51 cases)and a late group(42 cases).In the early group,there were 28 males and 23 females,with a gestational age of(34.12±1.75)weeks;in the late group,there were 22 males and 20 females,with a gestational age of(33.48±1.64)weeks.The early group was treated with Ps and NCPAP within 6 h after birth,while the late group was treated with Ps and NCPAP within 6-12 h after birth.The curative effect after 3 d of treatment,changes of blood gas indexes after 1 d and 7 d of treatment,assisted ventilation time,disappearance time of clinical symptoms,hospitalization time,and the occurrence of adverse reactions during hospitalization were compared between the two groups.t test was used for the measurement data andχ^(2) test was used for the count data.Results After 3 d of treatment,the response rate of treatment in the early group was 96.08%(49/51),which was higher than that in the late group[83.33%(35/42)],with a statistically significant difference(χ^(2)=4.280,P=0.039).After 1 d of treatment,the partial pressure of arterial oxygen,pH,and oxygenation index were improved in both groups,and those in the early group[(84.28±8.73)mmHg(1 mmHg=0.133 kPa),(7.16±0.28),and(194.58±17.42)mmHg]were higher than those in the late group[(75.13±7.89)mmHg,(7.02±0.26),and(176.08±21.05)mmHg],with statistically significant differences(all P<0.05);the partial pressure of carbon dioxide was decreased in both groups,and that in the early group was lower than that in the late group[(40.86±3.12)mmHg vs.(46.03±2.87)mmHg],with statistically significant differences(all P<0.05).After 7 d of treatment,there were no statistically significant differences in the blood gas indexes between the two groups(all P>0.05).The symptom disappearance time of shortness of breath,dyspnea,and three-concave sign and assisted ventilation time were(2.38±0.71)d,(2.01±0.51)d,(2.10±0.73)d,and(13.85±3.94)d,respectively,which were shorter than those in the late group[(3.52±1.02)d,(3.27±1.32)d,(3.08±0.94)d,and(15.68±4.21)d],with statistically significant differences(all P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusions There is no significant difference in the safety of Ps combined with NCPAP in the treatment of NRDS in different periods.However,the short-term curative effect of early treatment is more significant,which can accelerate the relief of clinical symptoms and the recovery of blood gas indexes.