早期应用泡式鼻持续气道正压通气8cmH2O和5cmH2O联合肺表面活性物质防治新生儿呼吸窘迫综合征的临床研究

目的探讨早期应用泡式鼻持续气道正压通气（B—NCPAP）8cmH2O（1cmH2O=0．098kPa）与肺表面活性物质（PS）＋B—NCPAP 5cmH2O防治NRDS的疗效差异。方法B—NCPAP8组选取2007年4月30日至2008年8月30日在中山大学附属第三医院分娩且生后30min内收入新生儿病房的早产儿，胎龄27～37周、羊水泡沫实验（-）～（＋），生后30min内应用B—NCPAP 8cmH2O，分为B—NCPAP8预防（治疗前未出现呼吸窘迫）和B—NCPAP8治疗亚组（治疗前出现呼吸窘迫，胸部X线检查提示存在不同程度NRDS改变）。Ps＋B—NCPAP5组选取为胎龄27—37周、羊水泡沫实验（一）～（＋）的早产儿，生后6h内气管内注入Ps并给予B—NCPAP5cmH20，分为PS＋B—NCPAP5预防及PS＋B-NCPAP5治疗亚组。结果研究期间，B—NCPAP8预防和治疗亚组分别纳入48和25例；PS＋B—NCPAP5预防和治疗亚组分别纳入36和22例。B—NCPAP8预防亚组41／48例（85．4％）未出现呼吸窘迫；7例在应用B—NCPAP4～6h后出现呼吸窘迫，其中5例为轻度NRDS，继续治疗8h后症状逐渐改善，2例为重度NRDS，在生后8～10h行气管插管注入PS并改用机械通气后存活；应用成功率为95．8％（46／48例）。PS＋B—NCPAP5预防亚组32／36例（88．9％）未出现呼吸窘迫；4例在应用BNCPAP4～6h后出现呼吸窘迫，其中3例为轻度NRDS，继续治疗后症状逐渐改善，应用成功率为97．2％（35／36例）；1／36例（2．8％）为中度NRDS，改用机械通气后死亡。B—NCPAP8治疗亚组24／25例（96．0％）治疗2h后血气分析指标改善，1例改用机械通气。PS＋B—NCPAP5治疗亚组18／22例（81．8％）治疗8h后临床症状及血气指标均改善，1／22例（4．5％）死亡。B—NCPAP8与PS＋B—NCPAP5预防及治疗亚组在防治NRDS的疗效上差异无统计学意义，但B—NCPAP8预防及治疗亚组的肺部感染发生率、住院时间及住院费用较低（P均〈0．05）。结论早期应用B．NCPAP 8cmH2O与PS＋B—NCPAP 5cmH2O预防及治疗NRDS的疗效相近，但前者能减少肺部并发症发生，缩短住院时间，减少住院费用。

A comparative study on early applying of B-NCPAP 8 cmH2O with PS Plus B-NCPAP 5 cmH2O in neonatal respiratory distress syndrome

Objective To determine whether early applying of B-NCPAP （with PEEP 8cm H2O ） or PS plus B-NCPAP （with PEEP 5 cm H2O ） can provide better effects in prophylaxis and treatment of neonatal respiratory distress syndrome. Methods B-NCPAP 8 group ：73 neonates aged 0.5 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving B-NCPAP（ starting at a pressure of 8 cmH2O with binasal prongs）. B-NCPAP 8 group was divided into 2 subgroups： 48 neonates in prevention subgroup（ B-NCPAP 8 P）, received B-NCPAP before development of NRDS, 25 in treatment subgroup（ B-NCPAP 8 T）, received B-NCPAP after development of NRDS. PS ＋ B-NCPAP 5 group ：58 neonates aged 6 h, with gestational age of 28 to 37 weeks, and the foam tests of amniotic fluid were negative or probably negative , receiving PS plus B-NCPAP（ starting at a pressure of 5 cmH2O with binasal prongs ）. PS ＋ B-NCPAP 5 group was divided into 2 subgroups： 36 neonates in prophylactic subgroup （PS ＋ B-NCPAP 5 P）, received PS before development of NRDS, 22 in treatment subgroup （ PS ＋ B-NCPAP 5 T）, received PS after development of NRDS. Results In 48 B-NCPAP 8 P infants ,41 infants were improved, the prophylactic achievement ratio was 85.4%. 7 infants got dyspnea after 4 -6 h of B-NCPAP,5 of them finally were improved, while 2 infants needed PS and mechanical ventilation. In 36 PS ＋ B-NCPAP 5 P infants ,32 infants were improved, the prophylactic achievement pencentage was 88.9 % , 4 infants got dyspnea , 3 of them finally were improved, while 1 infant needed PS and mechanical ventilation and 1 infant finally died of NRDS, the mortality rate was 2.7%. In 25 B-NCPAP C infants ,24 of them were improved, the curative ratio was 96% , only one of them got dyspnea after 4 -6 h of B-NCPAP and needed be given PS and mechanical ventilation after 24 h treatment of B-NCPAP. In 22 PS ＋ B-NCPAP 5 C infants , 18 of them were improved, the curative ratio was 81.8% ,one infant died, the mortality rate was 4.5%. The total time of supplemental oxygen administration, assisted ventilation, hospitalization and cost of hospitalization of B-NCPAP 8 group was shortened compared with PS ＋ B-NCPAP 5 group either in prevention or in treatment . Conclusions Early B-NCPAP （ with PEEP 8 cmH2O ） applying provided an equivalent effect compared with PS plus B-NCPAP （ with PEEP 5 cmH2O ） in prophylaxis and treatment of neonatal respiratory distress syndrome.