电动牙刷振背联合密闭式吸痰辅助治疗新生儿呼吸窘迫综合征的效果观察

目的观察电动牙刷振背联合密闭式吸痰辅助治疗新生儿呼吸窘迫综合征(NRDS)的效果。方法选取2020年1月至2021年6月胎龄≤32周、出生体重<1,500 g、出生后6 h内诊断NRDS且需气管插管有创机械通气早产儿80例,随机分为观察组(n=40)和对照组(n=40)。观察组采取电动牙刷振背后行密闭式吸痰(CSS)。对照组予新生儿窒息复苏面罩叩背后行开放式吸痰(OSS)。比较两组患儿血气分析中动脉血氧分压(PaO_(2))及动脉血二氧化碳分压(PaCO_(2))、血清白细胞介素-6(IL-6)、血清肿瘤坏死因子-α(TNF-α)、排痰量、机械通气时间、VAP发生率、支气管分泌物培养阳性率、颅内出血发生率、气胸发生率、支气管肺发育不良(BPD)发生率、早产儿视网膜病(ROP)发生率。结果观察组排痰操作后24 h及72 h血气分析指标中PaO_(2)比对照组升高,PaCO_(2)比对照组下降,差异均有统计学意义(P<0.05);观察组排痰后24 h及72 h炎症介质IL-6和TNF-α浓度低于对照组,差异有统计学意义(P<0.05);观察组排痰操作后24 h及72 h排痰量均高于对照组,有创机械通气时间比对照组明显缩短,VAP发生率比对照组明显降低,支气管分泌物培养病原菌阳性率显著低于对照组,差异均有统计学意义(P<0.05)。观察组颅内出血及BPD发生率比对照组明显降低,差异均有统计学意义(P<0.05);气胸及ROP发生率同对照组比较,差异无统计学意义(P>0.05)。结论电动牙刷振背联合CSS可缩短NRDS呼吸机使用时间,减少各种并发症的发生,值得临床推广使用。

Objective To observe the effect of electric toothbrush vibrating back combined with closed sputum suction in the adjuvant treatment of neonatal respiratory distress syndrome(NRDS).Methods 80 preterm infants with gestational age≤32 weeks,birth weight<1,500 g,admitted to our department within 6 hours after birth,diagnosed with NRDS and requiring invasive mechanical ventilation through tracheal intubation in the neonatal intensive care unit of our hospital from January 2020 to June 2021 were randomly divided into the observation group(n=40)and the control group(n=40).The observation group adopted the closed suction(CSS)behind the electric toothbrush vibration.The control group was given open sputum suction(OSS)behind the percussion of neonatal asphyxia resuscitation mask.The arterial oxygen partial pressure(PaO_(2))in blood gas analysis between two groups of children and arterial partial pressure of carbon dioxide(PaCO_(2)),serum leukocytes,Intermedium-6(IL-6),serum tumor necrosis factor-α(TNF-α),sputum volume,duration of mechanical ventilation,incidence of VAP,positive bronchial secretion culture,intracranial hemorrhage,pneumothorax,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP)were compared between the two groups.Results PaO_(2)in blood gas analysis index of the observation group 24 h and 72 h after expectoration was significantly higher than that in the control group,while the PaCO_(2)of the observation group was lower than that in the control group,with statistical significance(all P<0.05).a The levels of inflammatory mediator IL-6 and TNF-αin the observation group were significantly lower than those in the control group at 24 h and 72 h after expectoration,with statistical significance(all P<0.05).The sputum output in the observation group was significantly higher than that in the control group at 24 h and 72 h after expectoration,the time of invasive mechanical ventilation of the observation group was significantly shorter than that of the control group,the incidence of VAP of the observation group was significantly lower than that of the control group,and the positive rate of pathogenic bacteria cultured from bronchial secretions of the observation group was significantly lower than that of the control group,and the differences were statistically significant(all P<0.05).In terms of complications,the incidence of intracranial hemorrhage and BPD in the observation group was significantly lower than that in the control group(P<0.05),while the incidence of pneumothorax and ROP was not significantly different from that in the control group(P>0.05).Conclusion Electric toothbrush vibrating back combined with CSS can shorten the use time of NRDS ventilator and reduce the occurrence of various complications,which is worthy of clinical application.