肺表面活性物质与肺持续扩张压力联合应用治疗极低出生体重儿呼吸窘迫综合征

目的：探讨肺表面活性物质（PS）与肺持续扩张压力联合应用治疗极低出生体重儿呼吸窘迫综合征（RDS）的疗效及临床价值。方法：选取2003年1月至2006年12月收住我院新生儿科的所有患新生儿呼吸窘迫综合征的出生体重＜1 500 g、胎龄≤34周的极低出生体重儿90例作为研究对象，联合组应用PS与Infant Flow Advance系统提供的相对恒定的肺持续扩张压力联合治疗；PS组为单用PS治疗；CDP组单用Infant Flow Advance系统治疗。观察3组患儿治疗后1，6，12，24 h临床症状、体征、血气变化，并发症如肺部感染、慢性肺病及住院天数、早产儿视网膜病发生情况。结果：3组患儿治疗前PaO2，PaCO2，pH值比较无统计学意义，治疗后1，6，12，24小时PaO2，PaCO2，pH值与治疗前比较有明显改善（P＜0.01），联合组PaO2，PaCO2分别与PS组，CDP组组比较，差异有统计学意义（P＜0.01），联合组pH值与PS组、CDP组比较差异无统计学意义（P>0.05）。3组患儿氧疗时间比较，观察组与PS组，CDP组相比差异有统计学意义（P＜0.01），平均住院天数联合组少于其他两组（P＜0.01）。结论： PS与Infant Flow Advance系统联合应用，可有效治疗NRDS，减少机械通气率，缩短氧疗时间及住院天数，从而减少有创通气相关并发症。

Combined use of pulmonary surfactants with continuous distending pressure is useful in the treatment of respiratory distress syndrome in very low birth weight infants

Objective To study the efficacy of pulmonary surfactants(PS) combined with continuous distending pressure(CDP) for treatment of respiratory distress syndrome(RDS) in very low birth weight(VLBW) infants.Methods Ninety VLBW infants with RDS(weight <1 500 g,gestational age <34 weeks) were randomly treated with a combination of PS and the Infant Flow Advance system which can provide CDP,PS alone or the Infant Flow Advance system alone(n=30 in each group).Clinical symptoms,signs,and blood gas changes were assessed 1,6,12 and 24 hrs after treatment.The treatment outcomes were compared between the three groups.Results Clinical symptoms and signs,as well as the values of PaO2,PaCO2 and pH,in the three groups were improved 1,6,12 and 24 hrs after treatment.The combined use of PS with CDP produced a higher PaO2 and a lower PaCO2 compared with the PS or CDP use alone(P<0.01).The combination treatment group had shorter duration of oxygen therapy and shorter length of hospital stay than the PS or CDP use alone group.Conclusions The combined use of PS with CDP can effectively improve pulmonary oxygenation and ventilation and shorten the duration of oxygen therapy and the length of hospital stay in VLBW infants with RDS.