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目的探讨采用胃管代替气管导管注射肺泡表面活性物质(pulmonary surfactant,PS)在新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)患儿治疗中的应用效果。方法选择我院2012年3月~2015年9月在早产儿NRDS的替代中使用肺泡表面活性物质的患儿分为两组,将采用MIST方法的患儿确认为观察组(n=45);使用INSURE方法为对照组(n=45)。记录两组患儿使用肺泡表面活性物质的量,气管插管次数,插管时间,有创、无创通气时间,吸氧时间。观察治疗中患儿发生气胸,早期败血症等并发症及镇静治疗情况等。结果两组患儿在性别、胎龄、体重、产前激素使用率等方面比较,差异无统计学意义(P>0.05)。观察组在首次插管1次性成功率,首次气管插管时间,使用肺泡表面活性物质总剂量,再次使用肺泡表面活性物质的插管时间,有创、无创通气时间方面与对照组比较,差异有统计学意义(P<0.05)。且观察组中有69%的患儿不需要再次进行气管插管,而对照组患儿需要麻醉镇静的患儿增加,提高了气管插管率,延长了通气时间。结论采用MIST方法给药治疗损伤小,不需要镇静,减少给药次数,节约给药量,减少有创与无创通气时间,有效降低治疗期间患儿的并发征。
Objective To investigate the application of gastric tube instead of endotracheal tube for the treatment of neonatal respiratory distress syndrome (NRDS) in children with pulmonary surfactant (PS). Methods The children with alveolar surfactant in the replacement of NRDS in preterm infants from March 2012 to September 2015 in our hospital were divided into two groups. The children treated with MIST method were selected as the observation group (n = 45). The use of INSURE method for the control group (n = 45). The amount of alveolar surfactant, the number of tracheal intubation, intubation time, invasive, noninvasive ventilation and oxygen inhalation time were recorded. Observation of treatment of children with pneumothorax, early sepsis and other complications and sedation treatment. Results There was no significant difference in gender, gestational age, weight, prenatal hormone utilization between the two groups (P> 0.05). The difference between the observation group and the control group in the first successful rate of intubation, the time of first intubation, the total dose of alveolar surfactant, the time of re-use of alveolar surfactant intubation, invasive and non-invasive ventilation There was statistical significance (P <0.05). In addition, 69% of the children in the observation group did not need tracheal intubation again, while those in the control group needed narcotic sedation increased, tracheal intubation rate was increased, and the ventilation time was prolonged. Conclusions The MIST method is effective in reducing the damage, eliminating the need for sedation, reducing the frequency of administration, saving dosage, reducing invasive and noninvasive ventilation, and effectively reducing the complication of children during treatment.