不同通气方式联合肺表面活性物质治疗早产合并新生儿呼吸窘迫综合征的疗效

目的：探讨经鼻持续正压通气（NCPAP）与控制性通气（CMV）或同步间歇指令通气（SIMV）联合肺表面活性物质（PS）治疗早产合并新生儿呼吸窘迫综合征（NRDS）的临床意义。方法选择2010年1月至2013年3月于遂宁市中心医院新生儿科住院治疗的118例合并 NRDS早产儿为研究对象。将其按照不同治疗方式分别纳入研究组（n=61,采用 NCPAP联合PS治疗）,对照组（n=57,采用 CMV或 SIMV联合PS治疗）。本研究遵循的程序符合遂宁市中心医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象监护人的知情同意,并与之签署临床研究知情同意书。对两组合并 NRDS早产儿均于入院2 h内分别进行 NCPAP联合PS治疗与CMV或 SIMV联合PS治疗,观察其不同时段的血气分析结果、呼吸机使用时间、用氧时间、住院天数、并发症发生率及病死率等。结果①两组合并 NRDS早产儿的性别、胎龄、日龄、出生体质量及 NRDS 分级比较,差异均无统计学意义（P＞0.05）。②两组合并NRDS早产儿不同时段血气分析结果及病死率比较,差异亦无统计学意义（P＞0.05）。③研究组新生儿的呼吸机使用时间、用氧时间、住院天数及并发症发生率均显著低于对照组,且差异均有统计学意义（P＜0.05）。结论 NCPAP联合PS较CMV或 SIMV联合 PS治疗早产合并 NRDS,可缩短早产儿呼吸机使用时间、用氧时间及住院天数,降低并发症发生率,而且不会增加患儿病死率。NCPAP 是否为早产合并NRDS患儿更好体现肺保护性的通气治疗方式,尚需大样本、多中心随机对照研究进一步研究证实。

Effects of Different Mechanical Ventilation Modes Combined with Pulmonary Surfactant on the Treatment of Preterm Infants with Neonatal Respiratory Distress Syndrome

Objective To study the clinical effects of nasal continuous positive airway pressure （NCPAP）,controlled mandatory ventilation （CMV）or synchronized intermittent mandatory ventilation （SIMV）combined with pulmonary surfactant （PS）on the treatment of neonatal respiratory distress syndrome （NRDS）.Methods From January 2010 to March 2013,a total of 118 cases preterm infants with NRDS who hospitalized in Suining Central Hospital were selected into this study.They were divided into study group （n=61,accepted NCPAP combined with PS treatment）and control group （n=57,accepted CMV or SIMV combined with PS treatment）.The study protocol was approved by the Ethical Review Board of Investigation in Suining Central Hospital.Informed consent was obtained from the guardians of each participate.Within 2 h after hospitalization,NCPAP combined with PS（study group）,CMV or SIMV combined with PS（control group）were given to preterm infants with NRDS in two groups,respectively. Then results of blood gas analysis, duration of mechanical ventilation, duration of oxygen inhaled, hospitalization stay,incidence rate of complications and mortality were analyzed by statistic methods. Results ① There were no statistically significant differences between two groups in gender,gestational age,age,birth weight and NRDS classification （P〉0.05 ）.② There were no statistically significant differences between two groups in results of blood gas analysis at different time points and mortality （P〉0.05）.③Duration of mechanical ventilation,duration of oxygen inhaled,hospitalization stay,incidence＆amp;nbsp;rate of complications in study group were significantly lower than those in control group,and the differences were significance （P〈0.05 ）.Conclusions Compared with CMV or SIMV combined with PS,NCPAP combined with PS could diminish duration of mechanical ventilation, duration of oxygen inhaled, hospitalization stay,and reduce incidence rate of complications without increasing their mortality.Whether N