对比分析间歇正压通气与无创高频振荡通气分别联合微创肺表面活性物质治疗新生儿呼吸窘迫综合征疗效及安全性

摘要 目的：对比经鼻间歇正压通气（NIPPV）与无创高频振荡通气（nHFOV）分别联合微创肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征（RDS）的临床效果及安全性。方法：选择2019年1月至2021年12月我院新生儿科收治的100例RDS患儿作为研究对象，采用随机数字表法分为对照组和观察组，各50例。对照组新生儿采用NIPPV联合微创PS治疗，观察组新生儿采用nHFOV联合微创PS治疗。比较两组患儿治疗相关指标（机械通气时间、氧暴露时间、住院天数）、临床症状（吸气三凹征、进行性呼吸困难、气促）改善时间、血气指标脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）、氧合指数（OI）]、呼吸暂停发生率、通气失败率以及并发症发生率。结果：（1）观察组患儿机械通气时间、氧暴露时间、住院时间均较对照组少（P<0.05）。（2）观察组患儿进行性呼吸困难、吸气三凹征、气促改善时间均显著少于对照组（P<0.05）。（3）观察组患儿治疗72 h时的PaO₂显著高于对照组，PaCO₂和OI显著低于对照组（P<0.05）。（4）观察组呼吸暂停发生率和通气失败率为16.00%和10.00%，与对照组并无显著差异（P＞0.05）。（5）观察组术后并发症总发生率为4.00 %显著低于对照组的26.00 %（P<0.05）。结论：与NIPPV联合无创PS比较，nHFOV联合微创PS更能有效改善NRDS患儿肺通气功能，缩短机械通气时间，减少并发症。

Comparison of The Efficacy and Safety of NIPPV and nHFOV Combined with Minimally Invasive Pulmonary Surfactant in the Treatment of Neonatal Respiratory Distress Syndrome

ABSTRACT Objective: To compare the clinical effect and safety of nasal intermittent positive pressure ventilation (NIPPV) and noninvasive high frequency oscillatory ventilation (nHFOV) combined with minimally invasive pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: 100 children with NRDS admitted to the Department of Neonatology of our hospital from January 2019 to December 2021 were selected as the study subjects. They were randomly divided into the matched group and the observation group with 50 cases each. The newborns in the matched group were treated with NIPPV combined with minimally invasive PS, and the newborns in the observation group were treated with nHFOV combined with minimally invasive PS. The treatment-related indexes (mechanical ventilation time, oxygen exposure time, hospitalization days), improvement time of clinical symptoms (inspiratory triple concave sign, progressive dyspnea, and shortness of breath), blood gas indexes PaO₂, PaCO₂, OI] The incidence of apnea, ventilation failure and complications. Results: (1) The mechanical ventilation time, oxygen exposure time, hospitalization time of the children in the observation group were shorter than those in the matched group (P<0.05). (2) The improvement time of progressive dyspnea, inspiratory triple concave sign and shortness of breath in the observation group was shorter than that in the matched group (P<0.05). (3) The PaO₂ of the children in the observation group was higher than that in the matched group at 72 hours of treatment, and the PaCO₂ and OI were lower than that in the matched group(P<0.05). (4) The incidence of apnea and the failure rate of ventilation in the observation group were 16.00% and 10.00%, and there was no difference between the observation group and the matched group(P>0.05). (5) The total incidence of postoperative complications in the observation group was 4.00%, which was lower than that in the matched group (26.00%)(P<0.05). Conclusion: Compared with NIPPV combined with non-invasive PS, nhfov combined with minimally invasive PS can more effectively improve blood gas, shorten mechanical ventilation time and reduce complications in children with NRDS.