经鼻双水平正压通气联合肺表面活性物质、布地奈德治疗新生儿呼吸窘迫综合征的近期疗效及对降钙素原、C-反应蛋白的影响

Short-term Efficacy of Nasal Double Level Positive Pressure Ventilation Combined with Pulmonary Surfactant and Budesonide in the Treatment of Neonatal Respiratory Distress Syndrome and Its Influence on Procalcitonin and C-reactive Protein

目的 探讨经鼻双水平正压通气联合肺表面活性物质、布地奈德治疗新生儿呼吸窘迫综合征的近期疗效及对降钙素原、C-反应蛋白的影响。方法 将福建医科大学附属龙岩第一医院2020年1月至2022年3月收治的62例新生儿呼吸窘迫综合征按随机数字表分为对照组和观察组,每组各31例,对照组新生儿采取经鼻双水平正压通气联合肺表面活性物质治疗,观察组新生儿采取经鼻双水平正压通气联合肺表面活性物质、布地奈德联合治疗,比较两组新生儿症状缓解时间、无创辅助通气时间及住院时间,治疗前及治疗24 h进行动脉血气指标检测,治疗前及治疗48 h采用酶联免疫吸附试验法(ELISA)进行血清C-反应蛋白和降钙素原检测,治疗48 h后进行临床疗效评价,记录并发症发生情况。结果 观察组新生儿症状缓解时间、无创辅助通气时间及住院时间分别为(17.52±4.66)h、(71.75±3.74)h、(13.56±3.35)d,均明显短于对照组(30.26±5.04)h、(96.72±4.06)h、(17.57±3.73)d,均P<0.05。观察组新生儿治疗后动脉血氧分压、氧合指数分别为(61.80±2.02)mm Hg、(268.38±15.66)mm Hg,明显高于治疗前(44.68±1.06)mm Hg、(100.20±8.74)mm Hg及对照组治疗后(55.45±1.86)mm Hg、(200.08±14.26)mm Hg,P<0.05,动脉二氧化碳分压为(40.40±1.24)mm Hg,明显低于治疗前(50.92±2.40)mm Hg及对照组治疗后(45.03±1.58)mm Hg,均P<0.05。观察组新生儿治疗后血清C-反应蛋白和降钙素原分别为(4.65±0.40)mg/L、(210.52±42.58)pg/mL,明显低于治疗前(7.57±0.62)mg/L、(510.58±48.62)pg/mL及对照组治疗后(5.81±0.42)mg/L、(290.88±45.14)pg/mL,均P<0.05。观察组临床总有效率为93.55%(29/31),明显高于对照组74.19%(23/31),差异有统计学意义,χ^(2)=6.389,P<0.05。观察组不良反应总发生率为6.45%(2/31),明显低于对照组25.81%(8/31),差异有统计学意义,χ^(2)=4.292,P<0.05。结论 经鼻双水平正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的基础上加用布地奈德能有效改善新生儿动脉血气指标,降低降钙素原、C-反应蛋白,缩短无创辅助通气时间及住院时间,降低并发症发生率。

Objective To investigate the short-term efficacy of nasal double level positive pressure ventilation combined with pulmonary surfactant and budesonide in the treatment of neonatal respiratory distress syndrome(ARDS)and the effects on procalcitonin and C-reactive protein.Methods 62 cases of neonatal respiratory distress syndrome admitted to Longyan First Hospital Affiliated to Fujian Medical University from January 2020 to March 2022 were divided into control group and observation group according to random number table,with 31 cases in each group.Newborns in the control group were treated with nasal double level positive pressure ventilation combined with pulmonary surface active substances.Newborns in the observation group were treated with nasal double-level positive pressure ventilation combined with pulmonary surfactant and budesonide.Symptom relief time,non-invasive assisted ventilation time and hospital stay of the two groups were compared.Arterial blood gas indexes were detected before treatment and 24 hours after treatment.Serum C-reactive protein and procalcitonin were detected by enzyme-linked immunosorbent assay(ELISA)before and 48 hours after treatment.Clinical efficacy was evaluated after 48 hours of treatment,and complications were recorded.Results The duration of symptom relief,non-invasive assisted ventilation and hospital stay in the observation group were(17.52±4.66)h,(71.75±3.74)h and(13.56±3.35)d,respectively.It was significantly shorter than the control group(30.26±5.04)h,(96.72±4.06)h,(17.57±3.73)d,all P<0.05.In the observation group,the partial blood oxygen pressure and oxygenation index were(61.80±2.02)mm Hg and(268.38±15.66)mm Hg,respectively.It was significantly higher than that before treatment(44.68±1.06)mm Hg,(100.20±8.74)mm Hg and control group after treatment(55.45±1.86)mm Hg,(200.08±14.26)mm Hg.The arterial partial pressure of carbon dioxide(PCO2)was(40.40±1.24)mm Hg,significantly lower than before treatment(50.92±2.40)mm Hg and after treatment(45.03±1.58)mm Hg in the control group,both P<0.05.After treatment,the serum C-reactive protein and procalcitonin in the observation group were(4.65±0.40)mg/L and(210.52±42.58)pg/mL,respectively.It was significantly lower than before treatment(7.57±0.62)mg/L,(510.58±48.62)pg/mL and control group after treatment(5.81±0.42)mg/L,(290.88±45.14)pg/mL,all P<0.05.The total clinical effective rate of the observation group was 93.55%(29/31),which was significantly higher than that of the control group 74.19%(23/31),and the difference was statistically significant,χ^(2)=6.389,P<0.05.The total incidence rate of adverse reactions in the observation group was 6.45%(2/31),which was significantly lower than that in the control group 25.81%(8/31),and the difference was statistically significant(χ^(2)=4.292,P<0.05).Conclusion The combination of nasal positive pressure ventilation and pulmonary surfactant in the treatment of neonatal respiratory distress syndrome can effectively improve the arterial blood gas index,reduce procalcitonin and C-reactive protein,shorten the duration of non-invasive assisted ventilation and hospital stay,and reduce the incidence of complications.