早期与晚期应用肺表面活性物质联合经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征的比较研究

目的:比较早期与晚期应用肺表面活性物质(Ps)联合经鼻持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法:选取海南省三亚市人民医院于2014年1月～2018年7月期间收治的NRDS患儿100例,根据随机数字表法将患儿分为对照组(n=50)和研究组(n=50),对照组给予NCPAP治疗,研究组在对照组基础上联合Ps治疗,并根据Ps注入时间的不同将研究组患儿分为早期组(出生6h内注入,n=25)和晚期组(出生6～12h注入,n=25)。观察并比较对照组、早期组、晚期组患儿的临床疗效,并比较三组患儿治疗前、治疗1d后动脉血酸碱度(pH)、动脉二氧化碳分压(PCO_2)、动脉血氧分压(PO_2)、呼气末正压通气(PEEP)、吸入氧浓度(FiO_2)以及并发症发生情况。结果:早期组患儿临床总有效率高于对照组、晚期组(P0.05);而对照组、晚期组患儿临床总有效率比较差异无统计学意义(P0.05)。治疗1d后,三组患儿PCO_2较治疗前降低,PO_2较治疗前升高,且早期组PCO_2低于对照组、晚期组,PO_2高于对照组、晚期组(P0.05);但对照组、晚期组PCO_2、PO_2比较差异无统计学意义(P0.05)。治疗1d后,三组患儿PEEP、FiO_2较治疗前降低,且早期组低于对照组、晚期组(P0.05);但对照组、晚期组PEEP、Fi O2比较差异无统计学意义(P0.05)。三组患儿并发症总发生率比较差异无统计学意义(P0.05)。结论:与晚期相比,早期应用Ps联合NCPAP治疗NRDS疗效确切,其改善患儿血气指标及NCPAP参数的效果更佳,同时不会增加不良反应。

A Comparative Study of Early and Late Application of Pulmonary Surfactant Combined with Nasal Continuous Positive Airway Pressure in the Treatment of Neonatal Respiratory Distress Syndrome

ABSTRACT Objective: To compare the clinical efficacy of early and late application of pulmonary surfactant (Ps) combined with nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: 100 children with NRDS who were admitted to Sanya People''s Hospital from January 2014 to July 2018 were selected, they were divided into control group (n=50) and study group (n=50) according to the random number table method. The control group was treated with NCPAP, and the study group was treated with Ps on the basis of the control group. The children in study group were divided into early group (injected within 6 hours of birth, n=25) and late group (injected within 6 to 12 hours of birth, n=25) according to the injection time of Ps. The clinical effects of control group, early group and late group were observed and compared. The arterial pH(pH), partial arterial carbon dioxide (PCO₂), arterial oxygen partial pressure(PO₂), end-expiratory positive pressure ventilation (PEEP), oxygen concentration(FiO₂) and complications were compared in three groups before and 1d after treatment. Results: The total effective rate of early group was higher than that of control group and late group (P<0.05), but there was no significant difference between control group and late group (P>0.05). 1d after treatment, PCO₂ in three groups were lower than that before treatment, PO₂ was higher than that before treatment, and PCO₂ in early group was lower than that in control group and late group, PO₂ was higher than that in control group and late group (P<0.05). However, there was no significant difference in PCO₂ and PO₂ between control group and late group (P>0.05). 1day after treatment, PEEP and FiO₂ in three groups were lower than those before treatment, and those in the early group were lower than those in control group and late group (P<0.05), but there was no significant difference in PEEP and FiO₂ between control group and late group (P>0.05).There were no significant differences in the incidence of complications in three groups (P>0.05). Conclusion: Compared with advanced stage, early application of Ps combined with NCPAP in the treatment of NRDS is effective. It can improve the blood gas and NCPAP parameters of children, and it will not increase adverse reactions.