不同无创通气模式联合氨溴索治疗早产儿呼吸窘迫综合征的疗效观察

Effect of different non-invasive ventilation modes combined with ambroxol in the treatment of respiratory distress syndrome in premature infants

目的观察不同无创辅助通气模式联合氨溴索治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法回顾性分析2020年1月—2022年3月新生儿重症监护室收治的120例NRDS早产儿的临床资料,在氨溴索治疗基础上应用无创辅助通气。根据通气模式不同将早产儿分为经鼻持续气道正压通气(nCPAP)组和双水平正压通气(BiPAP)组,每组60例。比较2组患儿通气治疗后24 h的动脉血气分析指标以及氧疗时间、住院时间、无创通气时间和并发症发生率。结果治疗后,2组动脉血氧分压[p_(a)(O_(2))]及氧合指数(OI)增高,动脉血二氧化碳分压[p_(a)(CO_(2))]降低,且BiPAP组的p_(a)(O_(2))及OI高于nCPAP组,p_(a)(CO_(2))低于nCPAP组,差异有统计学意义(P<0.05)。BiPAP组的氧疗时间及住院时间均短于nCPAP组,差异有统计学意义(P<0.05);2组无创通气时间差异无统计学意义(P>0.05)。BiPAP组支气管肺发育不良(BPD)发生率低于nCPAP组,差异有统计学意义(P<0.05);2组肺部感染、颅内出血、动脉导管未闭(PDA)、气胸、早产儿视网膜病变(ROP)和气管插管发生率差异无统计学意义(P>0.05)。结论与nCPAP联合氨溴索相比,BiPAP联合氨溴索应用于NRDS早产儿呼吸支持治疗能够更有效地改善早产儿动脉血气指标水平,降低BPD发生率,缩短住院时间。

Objective To observe the clinical effect of different non-invasive auxiliary ventilation modes combined with ambroxol in the treatment of neonatal respiratory distress syndrome(NRDS).Methods The clinical data of 120 premature infants with NRDS admitted to the neonatal intensive care unit from January 2020 to March 2022 were analyzed.All of them were treated with non-invasive auxiliary ventilation on the basis of ambroxol,and were divided into nasal continuous positive airway pressure(nCPAP)group and bi-level positive airway pressure(BiPAP)group according to the ventilation modes,with 60 patients in each group.The artery blood gas analysis indexes of the two groups after 24 h after ventilation treatment as well as oxygen treatment time,hospital stay,non-invasive ventilation time and the incidence of complications were compared.Results The arterial partial pressure of oxygen[p_(a)(O_(2))]and oxygen index(OI)in the BiPAP group were higher than those in the nCPAP group,and the arterial partial pressure of carbon dioxide[p_(a)(CO_(2))]was lower than that in the nCPAP group(P<0.05).The duration of oxygen therapy and hospital stay in the BiPAP group were shorter than those in the nCPAP group(P<0.05).There was no significant difference in the duration of non-invasive ventilation between the two groups(P>0.05).The incidence of bronchopulmonary dysplasia(BPD)in the BiPAP group was lower than that in the nCPAP group(P<0.05).There were no significant differences in the incidence of pulmonary infection,intracranial hemorrhage,patent ductus arteriosus(PDA),pneumothorax,retinopathy of prematurity(ROP)and tracheal intubation between two groups(P>0.05).Conclusion Compared with nCPAP combined with ambroxol,BiPAP combined with ambroxol applied in premature infants with NRDS respiratory support can more effectively improve the arterial blood gas level of premature infants,reduce the incidence of BPD and shorten the length of hospital stay.