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目的探讨双水平正压通气(Duo-PAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选择2010年5月至2012年5月NICU收治的NRDS患儿64例,随机分为Duo-PAP联合肺表面活性物质(PS)治疗的观察组(31例)和鼻塞持续气道正压通气(NCPAP)联合PS治疗的对照组(33例),观察两组上机前后生命体征、PaO2、PaCO2改善情况、正压通气时间、氧疗时间、治疗成功率及气胸、支气管肺发育不良等并发症发生率和预后等。结果治疗开始时两组临床症状、PaO2、PaCO2差异无统计学意义(P均>0.05),治疗后PaO2、PaCO2均有改善(P<0.05,P<0.01),且治疗3、12h后观察组PaO2、PaCO2水平均优于对照组(P<0.05,P<0.01);观察组正压通气时间、氧疗时间均明显低于对照组(P均<0.05)。观察组治疗成功29例(93.5%),无效2例,无死亡病例;对照组治疗成功26例(78.8%),无效7例,其中死亡1例;观察组治疗成功率稍高于对照组,但差异无统计学意义(P>0.05)。无效病例均给予气管插管机械通气治疗。结论在应用PS的基础上,Duo-PAP治疗NRDS较NCPAP改善缺氧和二氧化碳潴留的疗效更优,且可缩短正压通气时间及氧疗时间。
Objective To investigate the clinical effect of double-level positive pressure ventilation (Duo-PAP) on neonatal respiratory distress syndrome (NRDS). Methods Sixty-four children with NRDS admitted to NICU between May 2010 and May 2012 were randomly divided into observation group (31 cases) treated with Duo-PAP combined with pulmonary surfactant (PS) and nasal continuous positive airway pressure (NCPAP) combined with PS (control group, 33 cases) were observed before and after treatment of vital signs, PaO2, PaCO2 improvement, positive pressure ventilation time, oxygen therapy time, treatment success rate and pneumothorax, bronchopulmonary dysplasia and other complications Disease incidence and prognosis. Results At the beginning of treatment, the clinical symptoms, PaO2 and PaCO2 were not significantly different between the two groups (P> 0.05), PaO2 and PaCO2 were improved after treatment (P <0.05, P <0.01) PaO2 and PaCO2 levels were significantly higher than those of the control group (P <0.05, P <0.01). The duration of positive pressure ventilation and oxygen therapy in the observation group were significantly lower than those in the control group (all P <0.05). In the observation group, 29 cases (93.5%) were successfully treated, 2 cases were ineffective, and no death was found. The control group was treated successfully in 26 cases (78.8%), 7 cases were ineffective, and 1 case died. The treatment success rate in the observation group was slightly higher than that in the control group But the difference was not statistically significant (P> 0.05). Invalid cases were given endotracheal intubation mechanical ventilation. Conclusion Based on the application of PS, Duo-PAP is more effective than NCPAP in improving hypoxia and carbon dioxide retention, and can shorten the duration of positive pressure ventilation and oxygen therapy.