双相气道正压通气治疗NRDS的疗效及对患儿脑氧代谢指标的影响

Effect of bi-level positive airway pressure in the treatment of neonatal respiratory distress syndrome and the influence on cerebral oxygen metabolism indicators

目的 探究双相气道正压通气治疗新生儿呼吸窘迫综合征(NRDS)的疗效及对患儿脑氧代谢指标的影响。方法 选取2018年11月至2021年11月宝鸡市人民医院收治的90例NRDS患儿为研究对象,采用随机数表法分为观察组和对照组各45例,两组患儿均采用常规治疗,在此基础上对照组患儿给予持续气道正压通气法治疗,观察组患儿给予双相气道正压通气法治疗,均治疗12 h。比较两组患儿治疗12 h后的疗效,治疗前后的全身氧代谢、脑氧代谢及并发症发生情况。结果 观察组患儿的治疗总有效率为97.78%,明显高于对照组的84.44%,差异有统计学意义(P<0.05);治疗后,两组患者的动脉血氧分压(PaO_(2))、氧合指数(OI)值均升高,且观察组分别为(112.88±2.12) mmHg、(262.59±22.31) mmHg,明显高于对照组的(100.22±2.23) mmHg、(223.43±20.16) mmHg,二氧化碳分压(PaCO_(2))吸入氧浓度(FiO_(2))值均降低,且观察组分别为(44.14±1.33) mmHg、(31.23±7.12)%,明显低于对照组的(53.16±1.27) mmHg、(41.11±7.11)%,差异均有统计学意义(P<0.05);观察组患儿治疗12 h内、治疗后5 min、治疗后10 min的脑氧饱和度(ScO_(2))值分别为(80.64±7.02)%、(84.03±4.17)%、(88.87±6.82)%,明显高于对照组的(77.47±7.39)%、(81.47±5.27)%、(83.36±6.97)%,差异均有统计学意义(P<0.05)。观察组患儿治疗期间的并发症总发生率为4.44%,明显低于对照组的20.00%,差异有统计学意义(P<0.05)。结论 较持续气道正压通气,双相气道正压通气治疗NRDS疗效更确切,对患儿全身氧代谢及脑氧代谢改善更显著,并具有更低的并发症风险。

Objective To investigate the effect of bi-level positive airway pressure in the treatment of neonatal respiratory distress syndrome(NRDS), and the influence on cerebral oxygen metabolism indicators. Methods A total of 90 neonates with NRDS admitted to People’s Hospital of Baoji City from November 2018 to November 2021 were selected and divided into an observation group and a control group by random number table method, with 45 cases in each group. On the basis of conventional treatment, neonates in the control group were treated with continuous positive airway pressure, and those in the observation group were treated with bi-level positive airway pressure. Both groups were given 12 h of treatment. The two groups were compared in terms of therapeutic effects after 12 h of treatment, systemic oxygen metabolism, and cerebral oxygen metabolism before and after treatment, and the incidence of complications.Results The total treatment response rate in the observation group(97.78%) was significantly higher than that in the control group(84.44%), and the difference was statistically significant(P<0.05). After treatment, arterial partial pressure of oxygen(PaO_(2)) and oxygenation index(OI) in the two groups were increased, and PaO_(2)and OI in the observation group were(112.88 ± 2.12) mmHg and(262.59 ± 22.31) mmHg, significantly higher than(100.22 ± 2.23) mm Hg and(223.43±20.16) mm Hg in the control group;the arterial partial pressure of carbon dioxide(PaCO_(2)) and inspired fraction of oxygen(FiO_(2)) were decreased, and the two in the observation group were(44.14±1.33) mmHg and(31.23±7.12)%,significantly lower than(53.16±1.27) mmHg and(41.11±7.11)% in the control group;the differences were statistically significant(P<0.05). The saturation of cerebral oxygen(ScO_(2)) in the observation group within 12 h of treatment, at 5 min and 10 min after treatment were(80.64±7.02)%,(84.03±4.17)%, and(88.87±6.82)%, significantly higher than(77.47±7.39)%,(81.47±5.27)%, and(83.36±6.97)% in the control group(P<0.05). The total incidence of complications in the observation group(4.44%) was lower than that in the control group(20.00%), and the difference was statistically significant(P<0.05). Conclusion Compared with continuous positive airway pressure, bi-level positive airway pressure is more effective in the treatment of NRDS, which can improve the systemic and cerebral oxygen metabolism more significantly, with a lower risk of complications.