不同时机应用NCPAP联合经胃管微创注入PS治疗新生儿呼吸窘迫综合征的效果观察

Efficacy of applying NCPAP combined with minimally invasive intragastric PS injection at different timings in the treatment of neonatal respiratory distress syndrome

目的探讨不同时机应用经鼻持续气道正压通气(NCPAP)联合经胃管微创注入肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法本研究选取2017年8月—2020年8月河南省某医院收治的82例NRDS患儿为研究对象。采用随机数字表法将患儿分为对照组、研究组,每组41例。对照组患儿于出生4 h后给予NCPAP联合经胃管微创注入PS治疗。研究组患儿则在出生2~4 h内给予NCPAP联合经胃管微创注入PS治疗。治疗2 d时,比较2组患儿的临床治疗效果。比较治疗前与治疗24 h时2组患儿氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧浓度分数(FiO_(2))等血气指标。比较2组患儿吸氧时间、住院时间及治疗2 d时并发症发生情况。结果研究组患儿治疗总有效率为90.24%,高于对照组的73.17%,差异有统计学意义(P<0.05)。治疗前,2组患儿PaO_(2)、PaCO_(2)、FiO_(2)水平比较,差异无统计学意义(P>0.05)。治疗24 h时,2组患儿PaCO_(2)、FiO_(2)水平均低于治疗前,且研究组低于对照组,差异均有统计学意义(P<0.05)。治疗24 h时,2组患儿PaO_(2)水平高于治疗前,且研究组高于对照组,差异均有统计学意义(P<0.05)。研究组患儿吸氧时间和住院时间均短于对照组,差异均有统计学意义(P<0.05)。研究组患儿并发症发生率为7.32%,低于对照组的24.40%,差异有统计学意义(P<0.05)。结论患儿出生2~4 h内应用NCPAP联合经胃管微创注入PS治疗NRDS,可改善患儿PaO_(2)、PaCO_(2)水平,减少并发症的发生,促进患儿康复,提高临床治疗效果,值得临床推广应用。

Objective To investigate the clinical effects of applying nasal continuous positive airway pressure(NCPAP)combined with minimally invasive intragastric injection of pulmonary surfactant(PS)at different timings for neonatal respiratory distress syndrome(NRDS).Methods Eighty-two children with NRDS admitted to a hospital in Henan from August 2017 to August 2020 were selected for this study.The children were divided into control and study groups using a random number table,with 41 cases in each group.The children in the control group were treated with NCPAP combined with minimally invasive intragastric PS injection 4 h after birth.The children in the study group were treated with NCPAP combined with minimally invasive intragastric PS injection within 2 to 4 h of birth.At 2 d of treatment,the clinical outcomes of the two groups were compared.The partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))and fraction of inspired oxygen(FiO_(2))were compared between the two groups before treatment and at 24 h of treatment.The duration of oxygenation,hospital stay and complications at 2 d of treatment were compared between the two groups.Results The total effective rate of treatment for the children in the study group was 90.24%,which was higher than that of the control group(73.17%),and the difference was statistically significant(P<0.05).Before treatment,there was no statistically significant difference between the PaO_(2),PaCO_(2) and FiO_(2) levels of the 2 groups(P>0.05).At 24 h of treatment,PaCO_(2) and FiO_(2) levels were lowered in both groups than before treatment and lower in the study group than in the control group,with statistically significant differences(P<0.05).At 24 h of treatment,the PaO_(2) level was raised in both groups than those before treatment and higher in the study group than in the control group,with statistically significant differences(P<0.05).The duration of oxygenation and hospital stay were shorter in the study group than in the control group,and the differences were statistically significant(P<0.05).The complication rate of children in the study group was 7.32%,which was lower than that of 24.40%in the control group,and the difference was statistically significant(P<0.05).Conclusion The application of NCPAP combined with minimally invasive intragastric PS injection for NRDS within 2 to 4 h of birth can improve PaO_(2),PaCO_(2),and FiO_(2) levels,reduce the occurrence of complications,promote the recovery of children,and improve the clinical treatment effect,which makes it worthy of clinical promotion.