早期应用泡式鼻持续气道正压通气8 cmH2O和5 cmH2O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

摘要 目的 探讨早期应用泡式鼻持续气道正压通气（B-NCPAP）8 cmH2O（1 cmH2O＝0.098 kPa）与肺表面活性物质（PS）+ B-NCPAP 5 cmH2O防治NRDS的疗效差异。方法 B-NCPAP 8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30 min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30 min内应用B-NCPAP 8 cmH2O，分为B-NCPAP 8预防(治疗前未出现呼吸窘迫)和B-NCPAP 8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-NCPAP 5组选取为胎龄27~37周、羊水泡沫实验（-）~（＋）的早产儿，生后6 h内气管内注入PS并给予B-NCPAP 5 cmH2O，分为PS+B-NCPAP 5预防及PS+B-NCPAP 5治疗亚组。结果 研究期间，B-NCPAP 8预防和治疗亚组分别纳入48和25例；PS+B-NCPAP 5预防和治疗亚组分别纳入36和22例。B-NCPAP 8预防亚组41/48例（85.4％）未出现呼吸窘迫；7例在应用B-NCPAP 4～6 h后出现呼吸窘迫，其中5例为轻度NRDS，继续治疗8 h后症状逐渐改善，2例为重度NRDS，在生后8～10 h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-NCPAP 5预防亚组32/36例（88.9％）未出现呼吸窘迫；4例在应用B-NCPAP 4～6 h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-NCPAP 8治疗亚组24/25例（96.0％）治疗2 h后血气分析指标改善，1例改用机械通气。PS+B-NCPAP 5治疗亚组18/22例（81.8％）治疗8 h后临床症状及血气指标均改善，1/22例（4.5％）死亡。B NCPAP 8与PS+B NCPAP 5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 NCPAP 8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 8 cmH2O与PS+B-NCPAP 5 cmH2O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

Abstract Objective To determine whether early applying of B-NCPAP(with PEEP 8cm H2O ) or PS plus B-NCPAP (with PEEP 5cm 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.