鼻塞持续正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的临床效果观察

目的 探讨鼻塞式气道正压通气（NCPAP）联合肺表面活性物质治疗新生儿呼吸窘迫综合征（NRDS）的临床效果.方法 选取浙江省东阳市人民医院2011年2月～2013年1月收治的NRDS新生儿50例,随机分为观察组及对照组,每组各25例.观察组使用NCPAP联合肺表面活性物质进行治疗,对照组采用常规机械通气联合肺表面活性物质治疗,观察比较两组患儿血气分析,肺部合并症、氧疗时间、住院时间和住院费用等.结果 ①两组治疗后各时间点pH值、动脉血氧分压（PaO2）、动脉血氧分压/吸氧分数比值（PaO2/FiO2）较治疗前有不同程度上升,动脉血二氧化碳分压（PaCO2）较治疗前有不同程度下降,差异均有统计学意义（P＜0.05）.②观察组患儿氧疗时间[（67±15）h]、住院时间[（13.5±6.1）d]、及住院费用与对照组比较,差异均有统计学差异（P＜0.05）.③观察组肺部感染、肺气漏、肺出血发生率均低于对照组,差异有统计学意义（P＜0.05）.结论 采用NCPAP联合肺表面活性物质能减少肺部感染等并发症的发生率,减少氧疗时间及住院费用,效果显著,值得推荐应用.

Clinical study of therapy effect for neonatal respiratory distress syndrome with pulmonary surfactant and NCPAP

Objective To study the clinical effect of pulmonary surfactant and NCPAP on neonatal respiratory distress syndrome.Methods 50 cases of newborn infants in People＇s Hospital of Dongyang City from February 2011 to January 2013 with a confirmed diagnosis of neonatal respiratory distress syndrome （NRDS were selected and divided into observation group and control group with 25 cases in each group.The observation group was treated with NPCP and pulmonary surfactant.The control group was treated with mechanical ventilation and pulmonary surfactant.The blood gas analysis of these infants,the pulmonary complications,oxygen cure time,hospital stays,hospitalization costs were studied.Results ①）pH value,PaO2,PaO2/FiO2 after the treatment in the two groups were higher than those before the treatment,PaCO2 after the treatment in the two groups were lower than that before the treatment,the differences were statistically significant （P ＜ 0.05）.②Oxygen cure time[（67±15） h],hospital stays [（13.5±6.1） d],hospitalization costs in observation group were found had statistically significant differences with control group （P ＜ 0.05）.③Occurrence rate of pulmonary infection,pulmonary air leak,pneumorrhagia in observation group were lower than those in control group,the differences were statistically significant （P ＜ 0.05）.Conclusion The combination of pulmonary surfactant and CPAP can significantly improve the NRDS within the primary treatment.