肺表面活性物质治疗新生儿呼吸窘迫综合征前给予nCPAP呼吸支持最佳时间窗的临床研究  

Clinical Study on the Optimal Time Window of nCPAP Respiratory Support before Pulmonary Surfactant Treatment for Neonatal Respiratory Distress Syndrome

作　　者：杨艳 岳少杰[2] 王团美 杨琴 祝立平 YANG Yan;YUE Shao-jie;WANG Tuan-mei;YANG Qin;ZHU Li-ping(Department of Neonatology,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha,Hunan,410004,China;Department of Neonatology,Xiangya Hospital of Central South University,Changsha,Hunan,410008,China)

机构地区：[1]南华大学衡阳医学院附属长沙中心医院新生儿科,湖南长沙410004 [2]中南大学湘雅医院新生儿科,湖南长沙410008

出　　处：《现代生物医学进展》2023年第9期1787-1790,1795,共5页Progress in Modern Biomedicine

基　　金：湖南省卫计委科研基金项目(A2016012)。

摘　　要：目的:探讨肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)前给予经鼻持续气道正压通气(nCPAP)呼吸支持的最佳时间窗。方法:选择2017年1月至2019年12月期间我院收治的NRDS患儿100例。根据随机数字表法分为A组(给予PS前预先进行小于2 h的nCPAP,n=33)、B组(给予PS前预先进行2-4 h的nCPAP,n=33)和C组(立即给予PS,n=34)。对比三组患儿的血气分析指标、肺功能指标、临床指标和并发症发生率。结果:A组、B组给予PS后4h、给予PS后24 h动脉血氧分压(PaO_(2))、pH值高于C组,且B组高于A组(P<0.05),而动脉二氧化碳分压(PaCO_(2))低于C组,且B组低于A组(P<0.05)。A组、B组给予PS后4 h、给予PS后24 h潮气量(VT)、肺动态顺应性(CD)高于C组,且B组高于A组(P<0.05),而吸气阻力(Raw)低于C组,且B组低于A组(P<0.05)。B组用药后3天内需气管插管行机械通气例数少于A组和C组,住院时间短于A组和C组(P<0.05),A组、C组的用药后3天内需气管插管行机械通气例数、住院时间对比无明显差异(P>0.05)。三组患儿并发症发生率未见统计学差异(P>0.05)。结论:给予PS前预先进行2-4h的nCPAP,可较好地改善患儿血气分析指标和肺功能,有助于改善患儿预后。Objective:To explore the optimal time window of respiratory support with nasal continuous positive airway pressure(nCPAP)before pulmonary surfactant(PS)treatment for neonatal respiratory distress syndrome(NRDS).Methods:100 children with NRDS who were admitted from January 2017 to December 2019 were selected.According to the random number table method,they were divided into group A(nCPAP less than 2 h before PS administration,n=33),group B(nCPAP 2-4 h before PS administration,n=33)and group C(PS administration immediately,n=34).The blood gas analysis indexes,pulmonary function indexes,clinical indexes and complication rate of the three groups were compared.Results:The arterial oxygen partial pressure(PaO_(2))and pH value of the group A and the group B at 4 h after PS administration and 24 h after PS administration were higher than those of the group C,and the group B was higher than the group A(P<0.05).The arterial carbon dioxide partial pressure(PaCO_(2))was lower than that of the group C,and the group B was lower than the group A(P<0.05).The volume tidal(VT)and lung dynamic compliance(CD)of the group A and group B at 4 h after PS administration and 24 h after PS administration were higher than those of the group C,and the group B was higher than the group A(P<0.05),while air way resistance(Raw)was lower than that of the group C,and the group B was lower than the group A(P<0.05).The number of cases requiring endotracheal intubation for mechanical ventilation 3 days after medication of the group B was less than that of the group A and group C,and the length of hospital stay was shorter than that of the group A and group C(P<0.05).There were no significant differences in the number of cases requiring endotracheal intubation for mechanical ventilation 3 days after medication and the length of hospital stay of the group A and group C(P>0.05).There was no significant difference in the incidence of complications of the three groups(P>0.05).Conclusion:The nCPAP for 2-4 h before PS administration can improve the blood ga

关 键 词：肺表面活性物质 新生儿呼吸窘迫综合征 经鼻持续气道正压通气 呼吸支持 时间窗 

分 类 号：R725.6[医药卫生—儿科] R563.8[医药卫生—临床医学]