肺表面活性物质联合持续气道正压通气治疗早产儿呼吸窘迫综合征疗效及护理  

The curative effect of pulmonary surfactant combined with continuous positive airway pressure on premature with respiratory distress syndrome

作　　者：王林丽 胡文辉 

机构地区：[1]浙江省丽水市妇幼保健院儿科,浙江丽水323000 [2]浙江省台州市恩泽医疗中心(集团)台州医院儿内科,浙江台州317000

出　　处：《中国现代医生》2013年第14期110-111,114,共3页China Modern Doctor

基　　金：浙江省医学会临床科研基金项目(2011ZYC-B4)

摘　　要：目的探讨肺表面活性物质联合经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征(NRDS)疗效及护理。方法选择45例早产儿NRDS,予以肺表面活性物质联合NCPAP治疗。治疗期间积极做好用药前药物及患儿准备,用药中注意给药中的配合、加强病情监测,给药后注意保暖和体位护理,加强病情监测和气道管理以及预防感染等护理。结果所有患儿治疗后症状、体征均有明显改善;治疗后2 h、6 hPaO2均有明显上升(P<0.01),PaCO2均有明显下降(P<0.05)。1例Ⅳ级患儿用药后12 h予以重复使用肺表面活性物质1次。患儿住院治疗期间共发生并发症8例,包括肺气肿2例、呼吸机相关肺炎3例、肺出血1例、呼吸暂停1例、脑出血1例;其中43例痊愈出院,另2例死于多脏器功能衰竭。结论肺表面活性物质与NCPAP联合治疗早产儿NRDS具有较好的临床效果,临床痊愈率较高。治疗期间做好给药前准备、给药中良好配合及用药后注意保暖,严密观察病情变化,做好气道护理,加强抗感染,预防和减少各种并发症,有利于改善患儿预后。Objective To explore the curative effect and nursing of pulmonary surfactant （PS） combined with continuous positive airway pressure（CPAP） on premature with respiratory distress syndrome（RDS）. Methods Forty-five premature with RDS were treated by PS combined with CPAP. During the treatment period, prepare medicine and the premature well actively andenhance the illness monitoring before and during the medicineuse respectively. Pay attention to warm keeping and body position nursing and airway management so as to prevent from infection. Results All the symptoms and sign of premature got improved. PaO2 after treatment 2 or 6 hours increased significantly compared with that before treatment （P 〈 0.01 ）. But PaCO2 reduced significantly （P 〈 0.05 ）. l premature with gradelV reused the pulmonary surfactant 1 time. 8 cases of complications were found duiring period of treatment, and these were pulmonia（3 cases）, emphysema （2 cases）, empsyxis （1 case）, apnea （1 case） and encephalorrhagia （1 case）. 43 cases were cured and 2 cases got multiple organ failure. Conclusion Treating premature with RDS by pulmonary surfactant combined with CPAP shows a certain curative effect. A good preparing before medicine use, careful cooperation during medicine use, warm keeping and illness monitoring and airway management and strong anti-infection and complication prophylaxis after medicine use would improve the prognosis.

关 键 词：呼吸窘迫综合征 早产儿 肺表面活性物质 经鼻持续气道正压通气 疗效 

分 类 号：R722.6[医药卫生—儿科] R473[医药卫生—临床医学]