经鼻双水平正压通气与持续正压通气治疗新生儿呼吸窘迫综合征的比较  

Comparison on Treatment of Neonatal Respiratory Distress Syndrome by Nasal Bi-level Positive Airway Pressure Ventilation and Continuous Positive Pressure Ventilation

作　　者：高存娇 

机构地区：[1]山东省菏泽市牡丹区妇幼保健院,山东菏泽274000

出　　处：《中国医学创新》2015年第3期63-66,共4页Medical Innovation of China

摘　　要：目的：比较经鼻双水平正压通气（Bi PAP）与经鼻持续正压通气（NCPAP）治疗新生儿呼吸窘迫综合征（NRDS）的临床疗效和安全性,以指导NRDS的临床治疗。方法：选取2012年3月-2014年8月期间本院NRDS患儿78例,随机分为观察组与对照组,每组各39例。在应用肺表面活性物质（PS）的基础上,对照组给予NCPAP治疗,观察组给予Bi PAP治疗。比较两组治疗前（T0）及治疗后1 h（T1）、12 h（T2）、24 h（T3）的动脉血气指标,比较两组治疗后临床疗效,以及通气时间、氧疗时间、住院时间,并发症情况。结果：观察组T3时点的p H,T2、T3时点的Pa O2,T1、T2、T3时点的Pa O2/Fi O2均高于对照组相应水平,差异有统计学意义（t=3.10-7.39,P〈0.05或P〈0.01）;T2、T3时点的Pa O2均低于对照组相应水平,差异有统计学意义（t=3.21、4.87,P〈0.05）。观察组与对照组治疗有效率分别为94.87%、86.84%,两组比较差异无统计学意义（χ^2=2.11,P〉0.05）,并发症率分别为26.32%、15.38%,两组比较差异有统计学意义（χ^2=4.27,P〈0.05）。观察组通气时间、氧疗时间及住院时间均少于对照组,差异有统计学意义（t=3.17-6.25,P〈0.05或P〈0.01）。结论：经鼻双水平正压通气通过多种机制增加了肺泡气体交换,提高了氧合能力,进而改善了呼吸窘迫综合征患儿的动脉血气指标和临床症状,且具有更高的治疗效率和更低的并发症率,取得了较为满意的临床疗效,优于经鼻持续正压通气治疗,对基层医院新生儿呼吸窘迫综合征的临床治疗具有一定的指导和借鉴意义。Objective： To compare the clinical effect and safety on treatment of neonatal respiratory distress syndrome（NRDS） by nasal bi-level positive airway pressure ventilation（Bi PAP） and continuous positive pressure ventilation（NCPAP）, to guide NRDS＇ clinical treat. Method： 78 cases with NRDS were selected from March 2012 to August 2014, and were randomly divided into observation group and control group, 59 cases in each group. Patients in control group were given NCPAP, and patients in observation group were given Bi PAP based on the application of pulmonary surfactant（PS）. Arterial blood gas index on time points of before treatment（T0）,1 h（T1）,12 h（T2）,24 h（T3） after treatment, also with clinical effect, duration of ventilation, oxygen therapy time, hospitalization time and complications of two groups were compared. Result： PH on T3, Pa O2 on T2 and T3, Pa O2/Fi O2 on T1, T2 and T3 of observation group were all higher than those of control group at the corresponding time points,the differences were statistically significant（t=3.10-7.39,P〈0.05 or P〈0.01）.Pa O2 on T2,T3 were lower than control group（t=3.21,4.87,P〈0.05）.Efficiency in observation group and control group were 94.87% and 86.84%, the difference was statistically significant（ χ^2=2.11,P〈0.05）,and complication rates were 26.32% and 15.38%,the difference was statistically significant（ χ^2=4.27,P〈0.05）. Duration of ventilation, oxygen therapy and hospitalization time were all lower than those of control group,the differences were statistically significant（t=3.17-6.25,P〈0.05 or P〈0.01）.Conclusion：Bi PAP ventilation increases alveolar gas exchange, improves oxygenation capacity by variety of mechanisms, also it improves NRDS cases＇ arterial blood gas index and clinical symptoms,has higher efficiency and lower complications, and gets more satisfactory clinical efficacy and it is superior than NCPAP, and it has certain guidance and reference significance to NRDS＇ clinical treatment.

关 键 词：新生儿 呼吸窘迫综合征 辅助通气 肺表面活性物质 

分 类 号：R722.1[医药卫生—儿科]