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目的探讨产前应用皮质激素(ACS)联合产后应用外源性肺表面活性物质(PS)与单一应用防治新生儿呼吸窘迫综合征(RDS)的疗效。方法选取2003年1月-2007年1月本院NICU收治的143例RDS新生儿。随机分为4组:第1组为产前应用ACS联合产后应用PS (n=36);第2组为单一产前应用ACS (n=33);第3组为单一产后应用PS (n=39);第4组为2种治疗措施均未采用(n=35)。对4组患儿的一般资料如性别、胎龄、出生体质量、分娩方式、Apgar评分、产时复苏情况、围生期并发症进行分析,并对不同组间应用鼻导管吸氧、头罩吸氧、持续呼吸道正压(CPAP)、机械通气(MV)等不同氧疗模式的时间,治愈的平均治疗时间及疗效进行比较。结果 4组患儿的一般资料和临床特征相似(Pa>0.05)。第1、2、3、4组采用鼻导管吸氧时间分别为(75.81±15.63)、(130.09±27.32)、(150.67±28.59)、(174.32±25.92) h (P=0.041);头罩吸氧时间分别为(37.16±5.51)、(55.29±11.71)、(62.69±12.39)、(100.75±28.10) h (P=0.047);CPAP时间分别为(24.33±4.41)、(27.44±4.47)、(26.53±3.13)、(56.50±5.50) h (P=0.005);MV时间分别为(56.12±15.65)、(110.19±21.59)、(127.79±26.36)、(156.61±12.92) h (P=0.009);第1组采用MV的几率最低。4组患儿住院天数分别为(15.89±1.29)、(21.61±2.30)、(28.31±3.40)、(32.73±4.57) d(P=0);治愈率分别为63.89%、51.52%、35.90%、20.0%(P=0.005)。结论产前应用ACS联合产后外源性补充PS是治疗RDS的最佳措施,单一产前应用ACS对RDS的疗效优于单一产后应用PS。
Objective To investigate the effect of prenatal application of corticosteroid (ACS) in combination with exogenous pulmonary surfactant (PS) and single application in the prevention and treatment of neonatal respiratory distress syndrome (RDS). Methods A total of 143 RDS newborns admitted to our hospital from January 2003 to January 2007 were selected. The first group was prenatal application of ACS combined with postpartum postpartum application of PS (n = 36); the second group was single prenatal application of ACS (n = 33); the third group was single postnatal application of PS (n = 39); Group 4 was not used for both treatments (n = 35). The general data of 4 groups of children such as sex, gestational age, birth weight, mode of delivery, Apgar score, labor recovery and perinatal complications were analyzed. Nasal catheter oxygen inhalation, hood Oxygen therapy, continuous positive airway pressure (CPAP), mechanical ventilation (MV) and other oxygen therapy time, the average duration of treatment and curative effect were compared. Results The general data and clinical features of four groups were similar (Pa> 0.05). The time of oxygen inhalation in nasal cannulas in groups 1, 2, 3 and 4 were (75.81 ± 15.63), (130.09 ± 27.32), (150.67 ± 28.59) and (174.32 ± 25.92) h respectively (P = 0.041) The time of oxygenation was (37.16 ± 5.51), (55.29 ± 11.71), (62.69 ± 12.39) and (100.75 ± 28.10) h respectively (P = 0.047). The CPAP time were (24.33 ± 4.41) and (27.44 ± 4.47) (26.53 ± 3.13) and (56.50 ± 5.50) h, respectively (P = 0.005). The MV time was 56.12 ± 15.65, 110.19 ± 21.59, 127.79 ± 26.36 and 156.61 ± 12.92, respectively ); Group 1 has the lowest chance of using MV. The hospitalization days were (15.89 ± 1.29), (21.61 ± 2.30), (28.31 ± 3.40), (32.73 ± 4.57) d (P = 0) in the 4 groups respectively. The cure rates were 63.89%, 51.52%, 35.90% , 20.0% (P = 0.005). Conclusions The prenatal application of ACS combined with post-partum exogenous PS supplementation is the best treatment for RDS. Single prenatal application of ACS is superior to single postnatal application of PS in the treatment of RDS.