INSURE技术联合T-piece治疗新生儿呼吸窘迫综合征的临床有效性

目的探讨新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)采用INSURE技术+Tpiece方法完成治疗的有效性。方法回顾性选取2023年1—12月齐齐哈尔医学院附属第二医院收治的50例RDS患儿的临床资料,根据不同的治疗方法分为对照组(25例,复苏囊+INSURE技术)、研究组(25例,INSURE技术+T-piece方法)。比较两组血氧饱和度最低值、平均吸氧浓度、鼻塞持续气道正压通气应用时间、心率、并发症发生率。结果研究组血氧饱和度最低值为(90.79±3.59)%,高于对照组的(81.33±2.85)%,差异有统计学意义(t=10.319,P<0.05)。研究组平均吸氧浓度、鼻塞持续气道正压通气应用时间、心率优于对照组,差异有统计学意义(P均<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论临床对RDS患儿在治疗期间,将INSURE技术以及T-piece方法进行充分结合,可有效改善患儿的氧合及血气指标,促进病情康复。

T-piece复苏器与自动充气式气囊在需气管插管的危重新生儿转运中的应用效果对比

目的比较T-piece复苏器与自动充气式气囊在需气管插管的危重新生儿转运中的应用效果。方法回顾性分析2012—2014年清华大学第一附属医院转运中需气管插管危重患儿79例,依据气管插管后连接设备的不同分成T-piece组37例和自动充气式气囊组42例。T-piece组于气管插管后连接T-piece复苏器和氧源;自动充气式气囊组于气管插管后连接自动充气式气囊和氧源。观察所有患儿疾病分布及转归情况,比较两组患儿血气分析指标〔p H值、二氧化碳分压(PCO2)和氧分压(PO2)〕、上机时间、多器官功能损害发生率及转归情况。结果两组患儿p H值、PCO2、PO2、上机时间比较,差异无统计学意义(P>0.05)。T-piece组患儿多器官功能损害发生率低于自动充气式气囊组,差异有统计学意义(P<0.05)。结论 T-piece复苏器与自动充气式气囊在改善通气方面效果相当,但T-piece复苏器多器官功能损害发生率低,在危重新生儿转运中具有优势。

INSURE技术联合T-piece治疗新生儿呼吸窘迫综合征的临床观察

目的探讨INSURE技术联合T-piece治疗新生儿呼吸窘迫综合征(RDS)的疗效。方法将我院新生儿病房2010年2月至2011年2月住院的RDS早产儿随机分为观察组与对照组。观察组予以T-piece联合INSURE技术,对照组予以复苏囊联合INSURE技术,比较两组患儿气管插管注入肺表面活性物质过程中血氧饱和度(SPO2)最低值、心率(HR)最低值、吸氧浓度(FiO2)平均值、二次加压给氧比例、鼻塞持续气道正压通气(nCPAP)应用时间、用药前及用药1h后血气情况、近远期并发症发生率。结果观察组和对照组各入选47例RDS早产儿,观察组SPO2和HR的最低值均高于对照组[SPO2:(90.8±3.6)%比(81.5±2.9)%,HR:(117.5±9.6)次/min比(110.1±9.1)次/min,P<0.05],二次加压给氧比例和FiO2均低于对照组[加压给氧比例:6.4%比19.1%,FiO2:(0.31±0.07)比(0.36±0.08),P<0.05]。治疗前两组患儿FiO2差异无统计学意义(P>0.05);治疗后1h观察组FiO2小于对照组[(26.2±4.4)比(28.8±5.8),P<0.05]。观察组颅内出血的发生率低于对照组(23.4%比44.7%,P<0.05),两组气胸、肺出血、支气管肺发育不良及早产儿视网膜病变的发生率差异无统计学意义(P>0.05)。结论应用T-piece联合INSURE技术治疗可以更好的改善RDS患儿氧合,减少气压伤及高氧损伤的时间,减少颅内出血的发生,不增加肺出血的发生,值得在临床推荐。

T-piece复苏器在产房中对早产儿复苏中的应用效果评价

目的:探讨T-piece复苏器在产房中对早产儿复苏中的应用效果。方法:选择2011年1月至2016年12月在本院产科出生的早产儿(胎龄28～37周)62例,随机分为对照组与观察组,各31例,对照组患儿给予自动充气式复苏囊正压人工通气,观察组患儿给予T组合复苏器正压人工通气,比较两组患儿1、5、10 min Apgar评分、肺气漏发生率,以及缺氧缺血性脑病、支气管肺发育不良、坏死性小肠结肠炎、动脉导管未闭、高胆红素血症率。结果:两组患儿胎龄、性别、分娩方式、出生体重、出生后1、5、10 min Apgar评分等方面差异均无统计学意义(P>0.05)。与对照组相比,观察组气漏发生率降低,差异有统计学意义(P<0.05)。两组患儿缺氧缺血性脑病、支气管肺发育不良、坏死性小肠结肠炎、动脉导管未闭、高胆红素血症率差异无统计学意义(P>0.05)。结论:T-piece复苏器在产房中早产儿窒息复苏中的应用效果显著,具有操作简单、效率高等优点,两组复苏成功率差别不大,但T-piece复苏器能可有效减少肺气漏的发生,进而降低新生儿的病死率。

机械通气患者的不同撤机方式的研究

目的通过对不同撤机方式的比较,探讨更好的撤机方式。方法 102例达到撤机指标的患者随机被分成SIMV+PSV、PSV、T-piece实验3组(每组n=34例)。监测3种不同撤机方式的撤机时间和撤机失败率;监测不同疾病的撤机时间。结果 SIMV+PSV组平均撤机时间是7.2d;PSV组平均撤机时间是4.8d;T-piece组平均撤机时间是4.7d;SIMV+PSV组与PSV组和T-piece组的平均撤机时间比较差异均有统计学意义(P<0.05);PSV组与T-piece组平均撤机时间比较差异无统计学意义(P>0.05)。从撤机失败率分析,SIMV+PSV为29.4%,PSV为14.7%,T-piece组44.1%;而SIMV+PSV组与PSV组和T-piece组比较差异均无显著性(P>0.05);PSV组与T-piece组比较差异有统计学意义(P<0.05)。从不同疾病的平均撤机时间分析AECOPD和多发创伤的患者平均撤机时间相对较长分别为6.3d和8.5d,而重症哮喘和重症肺炎患者平均撤机时间相对较短分别为2.9d和3.6d。结论 3种撤机方式比较PSV优于SIMV+PSV和T-piece实验。

新生儿气胸的病因及危险因素分析

目的探讨新生儿气胸的病因及危险因素。方法总结本院2010年7月至2012年6月收住的46例新生儿气胸的病因及危险因素。结果 46例气胸患儿中,足月儿40例,早产儿6例,治愈38例,好转4例,死亡4例。结论发生气胸的新生儿中足月剖宫产儿大于早产儿。气胸与剖宫产、肺部原发病、不正确的窒息复苏及不同人员复苏之间的差异有关。预防窒息、早产,防治肺部吸入、提高复苏人员复苏技巧及尽早使用T组合(T-Piece)复苏器,可减少气胸的发生率。

Comparison of Respiratory Outcome between Sustained Lung Inflation and Intermittent Positive Ventilation in Preterm Infants Requiring Resuscitation at Birth

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for intubation and subsequent respiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess the efficacy of initial sustained lung inflation compared to standard intermittent positive pressure ventilation (IPPV) in preterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that was conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September 2019. The study included 115 preterm infants between 26 - 32 weeks of gestation who needed resuscitation at delivery room. The infants were randomly allocated into 2 groups;SLI group: included the preterm infants who received the SLI at initial inflation pressure of 25 cm H2O for 15 seconds using the Neopuff/T piece. IPPV group: preterm infants who received standard resuscitation;IPPV using the self-inflating bag. The heart rate (HR), oxygen saturation (SpO2), oxygen requirement, and intubation rate as well as need of surfactant in the delivery room were assessed. All cases were evaluated after admission to the NICU for the need of mechanical ventilation in the first 72 hours of life, death in delivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post menstrual age (PMA). Results: The percentage of preterm infants who needed resuscitation was 25.5% from the total deliveries during the study period. 56.5% of them received SLI and 43.4% received conventional IPPV. There were no significant differences between the studied groups regarding gestational age, birth weight. Apgar score, heart rate, oxygen saturation was not significantly increased in the SLI group at fifth minutes of age. The percentage of infants who needed further resuscitation was 20% in SLI group and 12% in the IPPV group. There were no significant differences in need for surfactant, CPAP or ventilator among the studied groups. There were no significant differences in relation to complications as BPD, air leak or retinopathy and death between the two groups. Conclusion: This study showed that there was no advantage from use of SLI in delivery room using T-piece upon the conventional IPPV using self-inflating bag.