经鼻持续气道正压通气与经鼻间歇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临床效果研究

Clinical effects of nasal continuous positive airway pressure and nasal intermittent positive pressure ventilation combined with pulmonary surfactant in treatment of neonatal respiratory distress syndrome

目的 探讨经鼻持续气道正压通气(NCPAP)与经鼻间歇正压通气(NIPPV)联合肺表面活性物质(PS)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2022年10月—2023年3月杭州市妇产科医院收治的85例NRDS患儿的资料,根据治疗方式分为NCPAP组(NCPAP联合PS治疗,43例)及NIPPV组(NIPPV联合PS治疗,42例)。比较两组临床疗效及围术期相关指标,观察两组患儿治疗前后血气分析指标、肺功能指标、炎症细胞因子水平变化。结果 NIPPV组、NCPAP组治疗总有效率对比差异无统计学意义(92.86%vs. 88.37%,χ^(2)=0.113,P>0.05)。NIPPV组总氧疗时间及住院时间分别为(16.12±2.37)d、(27.69±3.97)d,均短于NCPAP组[(17.59±2.63)d、(30.05±4.31)d],差异均有统计学意义(均P<0.05)。NIPPV组治疗后动脉血氧分压(PaO_(2))、经皮血氧饱和度(SpO_(2))高于NCPAP组,动脉血二氧化碳分压(PaCO_(2))低于NCPAP组[(63.05±6.91)mm Hg、(96.27±1.53)%、(38.19±5.85)mm Hgvs.(58.96±7.13)mm Hg、(95.13±2.05)%、(40.73±5.31)mm Hg],差异均有统计学意义(均P<0.05)。NIPPV组呼气末正压、吸气峰压均小于NCPAP组,吸气氧浓度低于NCPAP组[(4.19±0.53) cm H_(2)O、(20.49±1.27) cm H_(2)O、(38.51±2.79)%vs.(4.53±0.57) cm H_(2)O、(21.63±1.51) cm H_(2)O、(41.02±2.38)%],差异均有统计学意义(均P<0.05)。NIPPV组治疗后C-反应蛋白(CRP)水平为(2.41±0.27)mg/L,低于NCPAP组[(2.55±0.31)mg/L],差异有统计学意义(P<0.05)。NIPPV组术后并发症发生率低于NCPAP组(P<0.05)。结论 NCPAP与NIPPV联合PS治疗对NRDS的临床疗效相当,但相比于NCPAP,NIPPV联合PS治疗可更好地减轻患儿机体缺氧程度,改善其肺功能,并可降低炎症细胞因子水平。

Objective To explore the clinical effects of nasal continuous positive airway pressure(NCPAP)and nasal intermittent pos⁃itive pressure ventilation(NIPPV)combined with pulmonary surfactant(PS)in treatment of neonatal respiratory distress syndrome(NRDS).Methods The data of 85 children with NRDS who were treated in Hangzhou Obstetrics and Gynecology Hospital from October 2022 to March 2023 were retrospectively analyzed,and the patients were divided into NCPAP group(NCPAP combined with PS,43 cases)and NIPPV group(NIPPV combined with PS,42 cases)according to different treatment methods.The clinical effects and perioperative re⁃lated indicators were compared between the two groups,and the changes of blood gas analysis indicators,pulmonary function indicators,and inflammatory factors were observed in the two groups before and after treatment.Results There was no statistically significant difference in the total effective rate of treatment between NIPPV group and NCPAP group(92.86%vs.88.37%,χ^(2)=0.113,P>0.05).The total oxy⁃gen therapy time and hospital stay were(16.12±2.37)days and(27.69±3.97)days in NIPPV group,respectively,which were shorter than those in NCPAP group[(17.59±2.63)days,(30.05±4.31)days,P<0.05].Arterial partial pressure of oxygen(PaO_(2))and trans⁃cutaneous oxygen saturation(SpO_(2))after treatment in NIPPV group were higher than those in NCPAP group,arterial partial pressure of car⁃bon dioxide(PaCO_(2))was lower than that in NCPAP group[(63.05±6.91)mm Hg,(96.27±1.53)%,(38.19±5.85)mm Hg vs.(58.96±7.13)mm Hg,(95.13±2.05)%,(40.73±5.31)mm Hg,all P<0.05].The positive end-expiratory pressure and peak inspir⁃atory pressure in NIPPV group were lower than those in NCPAP group,while the inspiratory oxygen concentration was lower than that in NCPAP group[(4.19±0.53)cm H_(2)O,(20.49±1.27)cm H_(2)O,(38.51±2.79)%vs.(4.53±0.57)cm H_(2)O,(21.63±1.51)cm H_(2)O,(41.02±2.38)%,all P<0.05].The level of C-reactive protein(CRP)after treatment was(2.41±0.27)mg/L in NIPPV group,which was lower than that in NCPAP group[(2.55±0.31)mg/L,P<0.05].The incidence rate of postoperative complications in NIPPV group was lower than that in NCPAP group(P<0.05).Conclusion NCPAP and NIPPV combined with PS have similar clinical efficacy in treatment of NRDS,but compared with NCPAP,NIPPV combined with PS can better relieve hypoxic degree,improve pulmonary function,and reduce the levels of inflammatory cytokines.