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目的:探讨在应用肺表面活性物质(PS)的基础上联合双水平正压通气(Duo PAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法:选取胎龄为29~33周患有重度NRDS,生后6 h内需要无创呼吸机支持的早产儿80例,随机分为使用Duo PAP治疗的观察组和经鼻持续气道正压通气(n CPAP)治疗的对照组,每组各40例,若两种方式不能维持,再给予气管插管呼吸机辅助通气。观察生后12 h、24 h、48 h内总有创呼吸支持率,使用无创呼吸支持后1 h、6 h、12 h、24 h、48 h的血气分析p H值、二氧化碳分压(Pa CO2)、氧分压(Pa O2)、氧合指数(OI)的变化及总呼吸支持时间、氧疗时间、住院时间及全静脉营养支持时间。结果:实际共有77例患儿纳入研究,其中Duo PAP组39例,n CPAP组38例。Duo PAP组在各时间点总插管有创呼吸支持率低于n CPAP组(P<0.05),Duo PAP组OI、Pa O2、p H在无创呼吸支持1 h、6 h、12 h均高于n CPAP组(P<0.05),Duo PAP组Pa CO2在无创呼吸支持后1 h、6 h、12 h、24 h均低于n CPAP组(P<0.05)。两组总呼吸支持时间、氧疗时间、住院时间及全静脉营养支持时间比较差异有统计学意义。结论:在应用PS基础上,早期使用Duo PAP治疗,可降低有创呼吸支持率,改善早产儿缺氧及二氧化碳潴留,值得临床推广使用。
Objective: To investigate the clinical effect of combined use of pulmonary surfactant (PS) and double level positive pressure ventilation (Duo PAP) on neonatal respiratory distress syndrome (NRDS). Methods: Eighty preterm infants with severe NRDS at gestational age of 29-33 weeks and non-invasive ventilator support within 6 hours after birth were randomly divided into two groups: observation group treated with Duo PAP and nasal continuous positive airway pressure (n CPAP) control group, 40 cases in each group, if the two methods can not be maintained, and then given intubation ventilator assisted ventilation. The total invasive respiratory support rate at 12 h, 24 h, 48 h after birth was observed. The values of p H and Pa (Pa) at 1 h, 6 h, 12 h, 24 h and 48 h after non- CO2, Pa O2, OI, total respiratory support time, oxygen therapy time, hospitalization time and total parenteral nutrition support time. RESULTS: A total of 77 children were included in the study, of which 39 were Duo PAP and 38 were n CPAP. Duo PAP group had a lower total invasive intubation support rate (P <0.05), and OI, Pa O2 and p H in Duo PAP group were higher than that of n CPAP group at 1 h, 6 h and 12 h In n CPAP group (P <0.05), PaCO2 in Duo PAP group was lower than n CPAP group (P <0.05) at 1 h, 6 h, 12 h and 24 h after noninvasive respiratory support. Total respiration support time, oxygen therapy time, hospitalization time and total parenteral nutrition support time were statistically significant difference. Conclusion: The early use of Duo PAP treatment based on the application of PS can reduce invasive support rate, improve hypoxia and carbon dioxide retention in premature infants, worthy of clinical promotion.