LISA联合不同无创通气模式治疗早产儿呼吸窘迫综合征的研究

Study on LISA Combined with Different Non-invasive Ventilation Modes in the Treatment of Respiratory Distress Syndrome in Premature Infants

目的:探讨微创肺表面活性物质给药(LISA)技术联合不同无创通气模式治疗早产儿呼吸窘迫综合征(RDS)的临床疗效及安全性。方法:选择2022年1月至2023年5月入住深圳市第二人民医院及河池市人民医院新生儿科的胎龄≤34周的RDS早产儿118例为研究对象。随机数字法分为经鼻间歇正压通气(NIPPV)组和经鼻持续气道正压通气(NCPAP)组。其中NIPPV组56例,NCPAP组62例。两组早产儿的肺表面活性物质(PS)给药方式均为LISA,给药前、给药中及给药后分别采用NIPPV和NCPAP无创通气模式治疗。比较两组早产儿给药前及给药后1 h、6 h时的血气分析指标、临床疗效、并发症及不良反应情况。结果:NIPPV组患儿注入PS后1 h、6 h的动脉血氢离子浓度指数(pH)、动脉血氧分压(PaO2)显著高于NCPAP组,动脉血二氧化碳分压(PaCO2)低于NCPAP组,差异均有统计学意义(P<0.05)。NIPPV组患儿72 h内有创通气率、多次使用PS比例、呼吸暂停发生率、无创通气时间、总氧疗时间均低于NCPAP组,差异均具有统计学意义(P<0.05)。两组患儿有创通气时间比较,差异无统计学意义(P>0.05)。NIPPV组患儿支气管肺发育不良(BPD)发生率低于NCPAP组,差异有统计学意义(P<0.05)。两组患儿早产儿视网膜病(ROP)、脑室内出血(IVH)、新生儿坏死性小肠结肠炎(NEC)、喂养不耐受(FI)、气漏综合征、PS药物反流及鼻损伤发生率比较,差异均无统计学意义(P>0.05)。结论:在LISA技术联合不同通气模式治疗早产儿RDS中,NIPPV能有效改善血气分析指标,减少二氧化碳潴留,可降低72 h内机械通气率、缩短无创呼吸支持时间,减少BPD的发生,可作为初始模式在早产儿RDS临床中运用。

Objective To explore the clinical efficacy and safety of less invasive surfactant administration(LISA)combined with different non-invasive ventilation modes in the treatment of respiratory distress syndrome(RDS)in premature infants.Methods From January 2022 to May 2023,118 preterm infants(gestation age≤34 weeks)with RDS born and treated in the Neonatology Department of the Second People's Hospital of Shenzhen and the People's Hospital of Hechi were randomly assigned into nasal intermittent positive pressure ventilation(NIPPV)group and nasal continuous positive airway pressure(NCPAP)group.Among them,there were 56 cases in the NIPPV group and 62 cases in the NCPAP group.Both groups were treated with LISA technique.NIPPV and NCPAP were treated before,during and after administration,respectively.the blood gas analysis before and 1 and 6 h after administration,clinical efficacy,complications and adverse reactions were compared between the two groups.Results The potential of hydrogen(pH)and arterial partial pressure of oxygen(PaO2)of NIPPV group at 1 h and 6 h after PS injection were significantly higher than those of NCPAP group at corresponding time points,while the arterial partial pressure of carbon dioxide(PaCO2)was lower than that of NCPAP group,with statistical significances(P<0.05).Compared with NCPAP group,the mechanical ventilation rate of tracheal intubation with in 72 h,the incidence of apnea,the rate of multiple use of PS,non-invasive respiratory support time and total oxygen use time were decreased in NIPPV group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the duration of invasive ventilation between the two groups of patients(P>0.05).The incidence of bronchopulmonary dysplasia(BPD)in NIPPV group was lower than that of NCPAP group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of retinopathy of prematurity(ROP),intra-ventricular hemorrhage(IVH),neonatal necrotizing enterocolitis(NEC),feeding intolerance(FI),air leakage syndrome,PS drug reflux and nasal injury between the two groups(P>0.05).Conclusion In the treatment of premature infants with RDS by LISA technology combined with different ventilation modes,NIPPV can effectively improve oxygenation,reduce carbon dioxide retention,reduce mechanical ventilation rate within 72 h,shorten the time of non-invasive respiratory support,and reduce the occurrence of BPD,which can be used as the initial mode in the clinical application of premature infants with RDS.