肺表面活性物质联合双相呼吸道正压通气治疗新生儿呼吸窘迫综合征的临床研究  

Clinical study of pulmonary surfactant combined with biphasic positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome

作　　者：蒋丽芳[1] 杨莲芳[1] 朱璐卡[1] 

机构地区：[1]义乌市中心医院儿科

出　　处：《中国临床药理学与治疗学》2016年第9期1042-1045,共4页Chinese Journal of Clinical Pharmacology and Therapeutics

摘　　要：目的:观察肺表面活性物质联合双相呼吸道正压通气(BIPAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及其对氧交换指标的影响。方法:86例行BIPAP的NRDS患儿根据是否使用肺表面活性物质(PS)分为对照组(未使用PS,35例)和观察组(使用PS,51例)。比较两组治疗前及治疗24、48h后的动脉血氧分压(PaO_2)、氧合指数(PaO_2/FiO_2)、pH值、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压与肺泡氧分压比值(PaO_2/PAO_2)、机械通气参数及存活率、机械通气时间、住院天数。结果:观察组的存活率为94.1%,高于对照组的85.7%。观察组的机械通气时间、用氧治疗时间、住院时间均少于对照组(P<0.01),治疗前两组的PaO_2、PaCO_2、pH、PaO_2/FiO_2、PaO_2/PAO_2之间的差异均无统计学意义(P>0.05)。治疗后,两组在24、48h时各指标均较治疗前逐渐改善。观察组在治疗后各时间点的PaO_2、pH、PaO_2/FiO_2、PaO_2/PAO_2均较对照组升高明显,PaCO_2降低明显(P<0.05)。治疗后,对照组呼气末正压(PEEP)呈升高趋势,观察组PEEP呈逐渐降低趋势(P<0.05)。观察组在治疗后各时间点的吸入氧浓度(FiO_2)、平均气道压力(MAP)、PEEP均较对照组降低明显,差异均有统计学意义(P<0.05)。结论:肺表面活性物质联合双相呼吸道正压通气治疗NRDS,可有效改善患儿的肺通气功能,降低患儿病死率,减少住院时间,改善预后。AIM： To observe the clinical effect of pulmonary surfactant combined with biphasic positive airway pressure（ BIPAP） treatment of neonatal respiratory distress syndrome and its effect on oxygen exchange indices. METHODS： 86 children with NRDS in the treatment of BIPAP were divided into control group（ not using PS,35 cases） and observation group（ using PS,51 cases）. The arterial oxygen tension（ PaO2）,oxygen index（ PaO2/ FiO2）,pH value,arterial carbon dioxide tension（ PaCO2）,arterial oxygen and oxygen alveolar partial pressure ratio（ PaO2/ PAO2）,mechanical ventilation parameters and survival,duration of mechanical ventilation,length of hospital stay in the two groups were compared. RESULTS： The survival rate of the observation group was 94. 1%,higher than 85. 7% of the control group. Duration of mechanical ventilation,the oxygen treatment time,duration of hospitalization in the observation group were less than those in the control group（P〈0. 01）. There were no statistics difference in PaO2,PaCO2,pH,PaO2/FiO2,PaO2/ PAO2 between the two groups before treatment（P〈0. 05）. After treatment,the index of the two groups gradually improved compared with before treatment. The levels of PaO2,pH,PaO2/FiO2,PaO2/ PAO2 in the observation group after treatment at each time point increased significantly compared with the control group,while PaCO2 was significantly lower（P〈0. 05）. After treatment,PEEP in the control group showed an increasing trend,while PEEP in observation group showed an decreasing trend（P〈0. 05）. FiO2,MAP,PEEP in observation group after treatment was significantly reduced compared with the control group at each time point,the difference was statistically significant（P〈0. 05）. CONCLUSION： The therapy of pulmonary surfactant combined with biphasic positive airway pressure ventilation in ERDS can effectively improve pulmonary function in children and reduce children mortality and hospitalization time as well as improve the prognosis.

关 键 词：肺表面活性物质 双相呼吸道正压通气 新生儿呼吸窘迫综合征 

分 类 号：R722[医药卫生—儿科]