早期应用BNCPAP防治新生儿呼吸窘迫综合征的临床研究  

Early Application of Bubble Nasal Continuous Positive Airways Pressure in Prophylaxis and Therapeutics of Neonatal Respiratory Distress Syndrome

作　　者：肖作源[1] 陈国娟[1] 唐新意[1] 张雪华[1] 黄师菊[1] 郭蕾[1] 李晓峰[1] 冯艳萍[1] 

机构地区：[1]中山大学附属第三医院新生儿科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2009年第1期78-81,87,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2006B36008010)

摘　　要：【目的】探讨早期应用压力为8cmH2O的气泡式鼻塞持续正压通气(BNCPAP)预防及治疗新生儿呼吸窘迫综合征(NRDS)的效果。【方法】56例胎龄27～37周、羊水泡沫实验(-～+)的早产儿,分为预防组31例(治疗前未出现呼吸窘迫);治疗组25例,(治疗前出现呼吸窘迫症状,胸片提示有不同程度NRDS改变)。均于生后半小时内应用压力为8cmH2O的BNCPAP预防和治疗NRDS。【结果】预防组31例中有27例未出现呼吸窘迫症状,预防成功率为87.1%。4例患儿4～6h后出现呼吸窘迫症状,其中2例(胸片为Ⅰ～Ⅱ级)继续治疗8h后症状逐渐改善;2例(胸片为Ⅲ～Ⅳ级)于生后8h行气管插管注入PS并改用机械通气,存活1例,死亡1例(为27周,死于大面积硬肿和感染性休克),死亡率为3.3%。治疗组25例中有24例治疗2h后血气改善,治疗6～8h后临床症状改善,BNCPAP治疗成功率为96%。1例在8h后呼吸困难加重行气管插管注入PS并改用机械通气最终存活。【结论】生后早期(半小时内)应用压力为8cmH2O的BNCPAP对于预防及治疗胎龄28周或以上早产儿NRDS是安全有效的。[Objective] To evaluate the effects of early bubble nasal continuous positive airways pressure （BNCPAP） （pressure of 8 emil20） in prophylaxis and treatment of neonatal respiratory distress syndrome （NRDS）. [ Methods ] We assigned 56 infants at 27-to-37-week gestation in the Department of Neonatal Intensive Care Unit in the Third Affiliated Hospital of SUN Yatsen University to early BNCPAP （pressure of 8 cmH2O） 0.5 h after birth. All the infants＇ foam tests of amniotic fluid were negative. The infants were divided into 2 groups： prophylactic group （PG） which was given BNCPAP before development of dyspnea or immediately after admission with X-ray changes and non-prophylactic group （NPG） which was given a BNCPAP after the development of dyspnea or X-ray changes. [ Results] With 31 infants in PG, 27 infants did not have respiratory distress syndrome, and the prophylactic achievement ratio was 87.1%. Only four infants got dyspnea after 4-6 h of BNCPAP, and two of them finally improved the syndrome. Two infants needed PS and mechanical ventilation 10 h after treatment of BNCPAP and finally one died of NRDS and infective shock in the 27th week. The success rate was 96.7%, while the mortality rate was 3.3 %. With 25 infants in NPG, 24 of them improved, and the success rate was 96%. Only one of them got dyspnea after 4- 6 h of BNCPAP and needed PS and mechanical ventilation 24 h after the treatment of BNCPAP. There was no pneumothorax or carbon dioxide retention. [Conclusions] Early BNCPAP （pressure of 8 cmH20） was significantly effective in prophylaxis and treatment of infants born more than 28-week gestation with neonatal respiratory distress syndrome.

关 键 词：新生儿呼吸窘迫综合征 气泡式鼻塞持续正压通气 预防 治疗 

分 类 号：R722.12[医药卫生—儿科]