肺表面活性物质联合双水平正压通气治疗新生儿呼吸窘迫综合征疗效观察  

Efficacy Observation of Pulmonary Surfactant Combined with Duo Positive Airway Pressure in Neonatal Respiratory Distress Syndrome

作　　者：王淑玉[1,2] 张恩胜[2] 王静[2] 王军[3] 

机构地区：[1]徐州医学院,江苏徐州221002 [2]山东省滕州市中心人民医院,山东滕州277500 [3]徐州医学院附属医院,江苏徐州221002

出　　处：《儿科药学杂志》2015年第11期24-27,共4页Journal of Pediatric Pharmacy

摘　　要：目的：探讨在应用肺表面活性物质（PS）的基础上联合双水平正压通气（Duo PAP）治疗新生儿呼吸窘迫综合征（NRDS）的临床疗效。方法：选取胎龄为29~33周患有重度NRDS,生后6 h内需要无创呼吸机支持的早产儿80例,随机分为使用Duo PAP治疗的观察组和经鼻持续气道正压通气（n CPAP）治疗的对照组,每组各40例,若两种方式不能维持,再给予气管插管呼吸机辅助通气。观察生后12 h、24 h、48 h内总有创呼吸支持率,使用无创呼吸支持后1 h、6 h、12 h、24 h、48 h的血气分析p H值、二氧化碳分压（Pa CO2）、氧分压（Pa O2）、氧合指数（OI）的变化及总呼吸支持时间、氧疗时间、住院时间及全静脉营养支持时间。结果：实际共有77例患儿纳入研究,其中Duo PAP组39例,n CPAP组38例。Duo PAP组在各时间点总插管有创呼吸支持率低于n CPAP组（P〈0.05）,Duo PAP组OI、Pa O2、p H在无创呼吸支持1 h、6 h、12 h均高于n CPAP组（P〈0.05）,Duo PAP组Pa CO2在无创呼吸支持后1 h、6 h、12 h、24 h均低于n CPAP组（P〈0.05）。两组总呼吸支持时间、氧疗时间、住院时间及全静脉营养支持时间比较差异有统计学意义。结论：在应用PS基础上,早期使用Duo PAP治疗,可降低有创呼吸支持率,改善早产儿缺氧及二氧化碳潴留,值得临床推广使用。Objective： To discuss the clinical curative effect in the treatment of neonatal respiratory distress syndrome treatment by pulmonary surfactant（ PS） combined with Duo positive airway pressure（ Duo PAP）. Methods： Gestational ages of 29 ~ 33 weeks of eighty premature infants with severe neonatal respiratory distress syndrome,within 6 h after birth need noninvasive ventilator support from Jan 2013 to Dec 2014 in our hospital were selected. All children treated by PS on the basis treatment,according to the order of admission were randomly divided into Duo PAP group（ n = 40） and n CPAP group（ n = 40）. If the two noninvasive ventilation methods were not effective,endotracheal intubation and mechanical ventilation were used. The total invasive respiratory support rates within 12,24 and 48 hours after birth were observed. The two groups were observed in terms of p H,Pa CO2,Pa O2,oxygenation index（ OI）,at 1,6,12,24 and 48 hours after using the noninvasive respiratory support. The total respiratory support time,oxygen therapy time,the hospitalization time and the total parenteral nutrition support time were observed. Results： Seventy-seven infanta were finally enrolled in the study,including 39 cases with Duo PAP group and 38 cases with n CPAP group. The total invasive respiratory support rate within 12,24 and 48 hours after birth were lower in the Duo PAP group than in the n CPAP group（ P〈0. 05）. The OI,Pa O2,p H in the Duo PAP group were higher than in the n CPAP group at 1,6,12 hours after noninvasive respiratory support（ P〈0. 05）. Pa CO2 was lower in the Duo PAP group than in the n CPAP group at 1,6,12,24 hours after noninvasive respiratory support（ P〈0. 05）. There were statistical significance in time of respiratory support,oxygen therapy,the hospitalization,total parental nutrition support time between the two groups（ P〈0. 05）. Conclusion： On the basis of PS,early application of Duo PAP could decrease the need for invasive respiratory support rate in preterm neonate

关 键 词：无创呼吸模式 呼吸窘迫综合征 双水平正压通气 持续气道正压通气 新生儿 

分 类 号：R725.1[医药卫生—儿科]