早期鼻塞持续气道正压通气在新生儿呼吸窘迫综合征的价值  

Early application of nasal continuous positive airway pressure in the value of neonatal respiratory distress syndrome

作　　者：吕玮[1] 滕颖[1] 黄金艳[1] 孙晓斌[2] 

机构地区：[1]沈阳市第五人民医院小儿内科,辽宁沈阳110023 [2]哈尔滨医科大学,黑龙江哈尔滨150081

出　　处：《西部医学》2016年第5期648-651,共4页Medical Journal of West China

基　　金：国家自然科学基金(81171725)

摘　　要：目的探讨鼻塞持续气道正压通气（NCPAP）在新生儿呼吸窘迫综合征（NRDS）中早期应用价值。方法选取2012年1月至2014年1月收治的100例NRDS新生儿作为研究对象,按确诊后2小时内是否行NCPAP辅助呼吸治疗分为观察组（45例）及对照组（55例）。对两组患儿治疗前、后的X线胸片变化情况、动脉血二氧化碳分压（PaCO2）、氧分压（PaO2）和pH值等血气指标进行检测和比较;对两组患儿的病死率、改行气管插管持续正压通气（sIPPV）的比例及时间、氧疗时间、恢复出生体质量所需时间、住院时间及支气管肺发育不良（BPD）等并发症的发生率进行比较。结果两组患儿治疗后的X线胸片表现均得了显著的改善,动脉血PaO2和pH均较治疗前显著升高（q=2.827-4.679,P〈0.05）,PaCO2较治疗前显著下降（q=2.736-4.521,P〈0.05）,而且在治疗2h后的时间点,观察组患儿的动脉血PaO2和pH均显著高于对照组（t=3.048、2.886,P〈0.05）,PaCO2显著低于对照组（t=2.237,P〈0.05）;观察组患儿的病死率显著低于对照组（χ^2=5.303,P〈0.05）,而且观察组患儿的sIPPV比例（χ2=6.857）、sIPPV时间（t=6.134）、氧疗时间（t=4.722）、恢复出生体质量所需时间（t=3.817）、住院天数（t=3.562）、BPD发生率（χ^2=6.574）均显著低于对照组（P〈0.05）。结论对新生儿出生2h内确诊的NRDS早期应用NCPAP治疗,可快速改善NRDS患儿的血气指标、纠正酸中毒状态,而且可达到降低病死率、并发症发生率、缩短患者氧疗时间和住院时间的效果,有利于降低治疗费用并改善患者的预后,具有临床推广应用价值。Objective To evaluate the value of early application of NCPAP in NRDS.Methods 100 neonatal NRDS,according to whether the line after diagnosis within 2hNCPAP assisted breathing therapy,were divided into observation group（45cases）and control group（55cases）.The X-ray changes,PaCO2,PaO2 and pH blood gas testing were observed before and after treatment.The died rate,ratio and time of diverted intubation continuous positive airway pressure（sIPPV）,oxygen therapy,the time required to recover birth weight,length of stay and bronchopulmonary dysplasia（BPD）and he incidence of complications were compared.Results X-ray performance had significant improvements after treatment.The arterial PaO2 and pH after treatment were significantly higher than that before treatment（q=2.736-4.521,P〈0.05）.At 2htime points after treatment,the arterial PaO2 and pH of observation group were significantly higher than that of the control group（t=3.048,2.886,P〈0.05）.PaCO2 of observation group were significantly lower than that of the control group（t=2.237,P〈0.05）.The mortality of the observation group was significantly lower than that of the control group（χ^2=5.303,P〈0.05）.The sIPPV proportion,sIPPV time,oxygen therapy,the time required to recover birth weight（t=3.817）,length of hospital stay and,BPD incidence（χ^2=6.574）of observation group were significantly lower than that in the control group（P〈0.05）.Conclusion Birth within 2hdiagnosed early application of NCPAP treatment of NRDS can quickly improve blood indicators of NRDS children,correct acidosis,reduce the mortality and morbidity,shorten hospital stay and patient oxygen therapy effect,reduce the cost of treatment and improve patient outcomes.

关 键 词：鼻塞持续气道正压通气 新生儿呼吸窘迫综合征 疗效观察 

分 类 号：R722.12[医药卫生—儿科]