经鼻无创高频振荡通气联合肺表面活性物质微创给药在极低出生体重早产儿呼吸窘迫综合征中的应用效果  

Application effect of non-invasive high-frequency oscillatory ventilation combined with minimally invasive administration of pulmonary surfactant in extremely low birth weight premature infants with respiratory distress syndrome

作　　者：田渤 郑东芳 付洪涛[1] 张芳[1] Tian Bo;Zheng Dongfang;Fu Hongtao;Zhang Fang(Department of Neonatology,Tangshan Maternal and Child Health Care Hospital,Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院新生儿科,唐山063000

出　　处：《中国医师杂志》2024年第8期1169-1173,1179,共6页Journal of Chinese Physician

基　　金：河北省2024年度医学科学研究课题计划(20242145)。

摘　　要：目的探究经鼻无创高频振荡通气(NHFOV)联合肺表面活性物质微创给药在极低出生体重早产儿呼吸窘迫综合征中的治疗效果。方法前瞻性选择2021年7月至2023年7月唐山市妇幼保健院收治的具备无创呼吸支持治疗指征的106例呼吸窘迫综合征极低出生体重早产儿。采用随机数字表法分为两组,每组53例。对照组予以常规经鼻持续气道正压通气(NCPAP)联合肺表面活性物质微创给药治疗,观察组予以NHFOV联合肺表面活性物质微创给药治疗。治疗24 h后,比较两组患儿的动脉血二氧化碳分压(PaCO_(2)),检测血清转化生长因子-β1(TGF-β1)、高迁移率族蛋白B1(HMGB1)水平。记录患儿的无创通气时间、总吸氧时间、机械通气率、>1次肺表面活性剂使用率、并发症及病死率。结果治疗前、治疗后1、24 h,两组患儿的PaCO_(2)逐渐降低,差异有统计学意义(均P<0.05);治疗后1、24 h,观察组患儿的PaCO_(2)低于对照组(均P<0.05)。观察组患儿的机械通气率低于对照组(P<0.05);两组患儿的无创通气时间、总吸氧时间及>1次肺表面活性剂使用率比较,差异无统计学意义(均P>0.05)。治疗后,两组患儿的血清TGF-β1、HMGB1均较治疗前降低(均P<0.05),组间比较差异无统计学意义(均P>0.05)。两组患儿支气管肺发育不良、视网膜病变、坏死性小肠结肠炎、脑室内出血、肺气漏、鼻损伤及病死率比较,差异均无统计学意义(均P>0.05)。结论NHFOV联合肺表面活性物质微创给药治疗极低出生体重早产儿呼吸窘迫综合征,有助于改善CO_(2)潴留,降低机械通气比例,且不增加呼吸支持治疗相关并发症及病死率。ObjectiveTo investigate the therapeutic effect of nasal non-invasive high-frequency oscillatory ventilation(NHFOV)combined with minimally invasive administration of pulmonary surfactant in the treatment of respiratory distress syndrome in extremely low birth weight premature infants.MethodsA prospective study was conducted on 106 premature infants with respiratory distress syndrome and extremely low birth weight who were admitted to the Tangshan Maternal and Child Health Care Hospital from July 2021 to July 2023 and had indications for non-invasive respiratory support therapy.They were divided into two groups using a random number table method,with 53 cases in each group.The control group was treated with routine nasal continuous positive airway pressure(NCPAP)combined with minimally invasive administration of pulmonary surfactant,while the observation group was treated with NHFOV combined with minimally invasive administration of pulmonary surfactant.After 24 hours of treatment,arterial partial pressure of carbon dioxide(PaCO_(2))was compared between two groups of children,and serum levels of transforming growth factor beta 1(TGF-β1)and high mobility group protein B1(HMGB1)were measured.The non-invasive ventilation time,total oxygen inhalation time,mechanical ventilation rate,>1 use of pulmonary surfactant,complications,and mortality rate of the patient were recorded.ResultsBefore treatment and at 1 and 24 hours after treatment,the PaCO_(2)levels of the two groups of children gradually decreased,and the difference was statistically significant(all P<0.05);After 1 and 24 hours of treatment,the PaCO_(2)levels in the observation group were lower than those in the control group(all P<0.05).The mechanical ventilation rate of the observation group was lower than that of the control group(P<0.05);There was no statistically significant difference(P>0.05)in the non-invasive ventilation time,total oxygen inhalation time,and usage rate of pulmonary surfactant>1 time between the two groups of children.After treatment,the s

关 键 词：婴儿 极低出生体重 呼吸窘迫综合征 新生儿 高频通气 肺表面活性物质 

分 类 号：R722.6[医药卫生—儿科]