固尔苏预防早产儿呼吸窘迫综合征的临床研究

目的 评价固尔苏预防早产儿呼吸窘迫综合征（NRDS）的临床疗效及安全性。方法 将48例胎龄27～32周、体重900～1500g的早产儿随机分为两组，预防组生后2h内气管内滴入固尔苏，对照组不用固尔苏，两组患儿均给予相同的综合治疗，比较两组发生NRDS的比例、需要呼吸机治疗的比例、开始上机时间、机械通气的时间及胸片改变的严重程度。结果 （1）预防组发生NRDS的比例、需要呼吸机治疗的例数及呼吸机辅助通气时间较对照组少，二者比较有统计学意义（P〈0．05）；（2）两组发生NRDS的患儿胸片改变预防组比对照组程度轻。结论 早产儿生后预防性应用固尔苏可以降低NRDS发生率及减轻发病程度，固尔苏使用是安全的。     

固尔苏预防早产儿呼吸窘迫综合征的临床评价

目的探讨固尔苏预防早产儿呼吸窘迫综合征的疗效。方法将胎龄≤32周,体重≤1500g的同条件早产儿31例随机分为2组进行临床研究,预防组16例,出生后1h气管内滴入固尔苏;对照组15例,未应用固尔苏。结果预防组发生新生儿呼吸窘迫综合征(NRDS)、死亡及出现并发症的例数较对照组少(P<0.05),出生后8h血气分析结果预防组优于对照组(P<0.01)。结论预防性应用固尔苏可降低NRDS的发病率、减轻病情,减少辅助通气的应用,减少并发症的发生。     

固尔苏防治早产儿呼吸窘迫综合征13例

目的　探讨固尔苏对早产儿呼吸窘迫综合征 (RDS)的防治作用。方法　对 13例呼吸窘迫的早产儿应用猪肺表面活性物质固尔苏治疗 ,并对其临床特点、疗效等进行分析。结果　应用固尔苏后不久 12例发绀和呼吸困难症状均有减轻或消失 ,X线表现肺透亮度明显改善或病变未进展。 13例中 10例治愈出院 ,2例死亡 ,分别死于张力性气胸和RDS ,1例放弃治疗。结论　固尔苏能有效防治早产儿RDS ,且合理掌握用药指征和时机及对并发症的防治和固尔苏的疗效较为重要。     

产前应用地塞米松预防早产儿呼吸窘迫综合征

目的探讨产前应用地塞米松预防早产儿呼吸窘迫综合征(RDS)的疗效。方法胎龄为28~35周单胎早产儿234例。凡产前首剂使用地塞米松至胎儿娩出时间超过24h但不足7d者为治疗组(98例);首剂使用地塞米松至胎儿娩出时间不足24h或未使用地塞米松治疗者为对照组(136例)。分析两组RDS发病情况。结果治疗组和对照组早产儿RDS的发生率分别为1.02%和9.56%(P<0.01);治疗组和对照组新生儿败血症发生率分别为6.12%和1.47%(P<0.01);治疗组和对照组新生儿死亡率分别为3.06%和10.29%(P<0.05)。结论对于<35周的早产儿,产前应用地塞米松可促进其肺成熟。     

盐酸氨溴索预防早产儿呼吸窘迫综合征疗效观察

目的探讨大剂量盐酸氨溴索预防早产儿呼吸窘迫综合征的疗效。方法38例胎龄≤32周、体质量≤2 000 g的早产儿预防性静脉滴注大剂量盐酸氨溴索（治疗组）,并与38例未用盐酸氨溴索的早产儿（对照组）进行临床对照研究,二组均予常规治疗,比较二组早产儿呼吸窘迫综合征（RDS）发生率、吸氧时间、并发症。结果治疗组发生RDS 12例,发生率31.5%;对照组发生RDS15例,发生率39.6%,二组比较差异无统计学意义（P〉0.05）。发生RDS后治疗组病情、吸氧时间、并发症、病死率均低于对照组,有显著性差异（Pa〈0.05）。结论早产儿预防性应用大剂量盐酸氨溴索不能减少RDS发病,但可减轻RDS病情、减少吸氧时间及并发症。     

肺表面活性物质预防早产儿呼吸窘迫综合征疗效观察

目的 探讨肺表面活性物质(PS)预防早产儿呼吸窘迫综合征(RDS)的疗效。方法2001年3月～2002年6月我院产科出生早产儿22例；胎龄29～32周；体重1050～1720g。将其分为预防组10例，治疗组12例。预防组于生后30min内即从气管插管内滴入PS(Curosurf，120mg)，用药后应用鼻塞持续气道正压(CPAP)辅助呼吸；治疗组于确诊RDS后应用PS，方法同预防组。结果预防组CPAP辅助呼吸时间、鼻管法氧疗时间明显缩短；PaO2、PaCO2、pH与治疗组比较有显著差异；预防组均存活，不用机械通气，无肺出血、支气管肺发育不良等并发症。结论应用PS预防早产儿RDS，可减轻病情，避免机械通气、缩短氧疗时间，减少早期及后期并发症。     

固尔苏预防新生儿呼吸窘迫综合征33例临床分析

新生儿呼吸窘迫综合征(NRDS)主要由肺表面活性物质(PS)缺乏引起，多发生在早产儿，是造成早产儿死亡的主要原因。固尔苏是从猪肺中分离出来的天然肺表面活性物质制剂。2002年11月-2003年6月，我科应用固尔苏预防新生儿呼吸窘迫综合征共33例，效果显著，现报告如下。     

沐舒坦不同给药方式预防早产儿呼吸窘迫综合征疗效观察

目的：沐舒坦具有促进肺表面活性物质合成和分泌的作用。近年来已有较多学者将其用于预防早产儿呼吸窘迫综合征(RDS),取得了较好的临床疗效。该研究旨在比较静脉和雾化两种不同途径使用沐舒坦预防早产儿RDS的疗效。方法：将我院产科出生的早产儿(胎龄28～37周)随机分为静脉给药组、雾化吸入组两个用药组及未用沐舒坦的对照组,静脉给药组于出生后立即从脐静脉注射沐舒坦15mg/kg,随后静脉点滴每日30mg/kg,分2次给药;雾化给药组给予氧气驱动雾化吸入沐舒坦每日30mg/kg,分2次给药,均用药2d;对照组不使用沐舒坦。比较3组RDS的发生率、并发症及住院6h血气分析结果。结果：①静脉给药组RDS的发生率为7.5%,雾化给药组为5.0%,对照组为24.4%,两用药组间比较差异无显著性,但均低于对照组(P<0.05)。②两用药组住院6h的血气分析结果与对照组比较差异有显著性(P<0.05),两用药组间比较差异无显著性。③两用药组并发症发生率明显低于对照组(P<0.05),两用药组间比较差异无显著性。结论：新生儿早期使用沐舒坦预防RDS,具有一定疗效,无论是经静脉还是雾化给药,均能获得相同的效果。     

常频和高频机械通气治疗新生儿呼吸窘迫综合征的临床研究

目的 评价肺保护通气策略的常频和高频机械通气治疗早产儿呼吸窘迫综合征(NRDS)的疗效及安全性.方法 56例行机械通气的NRDS早产儿,分为常频机械通气(CMV)组和高频机械通气(HFOV)组,记录两组的血气和呼吸机参数的变化情况,观察两组的临床疗效及慢性肺疾病(CLD)、肺气漏(PAL)、III-IV级颅内出血(IVH)、脑室周围白质软化(PVL)等并发症的发生率.结果 HFOV组患儿氧合迅速改善,24 h内吸入氧浓度、氧合指数、平均气道压下降明显,差异具有显著性(F=4.23、5.09、4.37,P均＜0.05).24 h时HFOV组吸入氧浓度与CMV组比较,差异有显著性(t=2.181,P＜0.05).CMV组治愈27例,死亡3例;HFOV组治愈24例,死亡2例,两组比较差异无显著性(χ2=0.091,P＞0.05).CMV组并发CLD 1例、PAL 2例、IV级IVH 2例、PVL 1例;HFOV组并发CLD、PAL、III级IVH、IV级IVH 、PVL各1例.两组CLD、PAL、IVH、PVL发生率比较差异均无显著性(χ2=0.015、0.015、0.241、0.007,P均＞0.05).CMV组机械通气时间(86.5±20.5) h,HFOV组(60.5±16.5) h,两组比较差异有非常显著性(t=2.641,P＜0.01).CMV组住院时间(34.5±8.5) d,HFOV组(28.5 ±6.5) d,两组比较差异有显著性(t=2.015,P＜0.05).结论 肺保护通气策略的CMV和HFOV治疗NRDS是有效和安全的,HFOV能迅速改善氧合,缩短上机和住院时间.     

盐酸氨溴索预防早产儿呼吸窘迫综合征疗效观察

目的　探讨盐酸氨溴索预防早产儿呼吸窘迫综合征 (RDS)的临床疗效。方法　将 86例早产儿随机分为观察组 4 6例 ,对照组 4 0例。两组均予一般治疗 ,观察组在此基础上加用盐酸氨溴索 30mg/(kg·d)治疗。结果　观察组早产儿RDS发生率为 4 .35 % ,对照组为 2 2 .5 0 % ,两组有显著差异 (P <0 .0 5 )。结论　盐酸氨溴索对预防早产儿RDS有一定疗效     

不同时间给予肺表面活性物质治疗对呼吸窘迫综合征早产儿的影响

目的探讨早期或晚期给予肺表面活性物质(PS)治疗对呼吸窘迫综合征(RDS)早产儿的影响。方法本院新生儿科2009—2010年收治的RDS早产儿,按照PS的给予时间分为早期组(出生2 h内给药)和晚期组(出生2～12 h给药),比较两组机械通气时间、氧疗时间、病死率以及并发症发生率方面的差异。结果早期组48例,晚期组51例,早期给予PS能显著减少机械通气时间和氧疗时间[机械通气时间:(4.1±1.9)天比(5.4±2.2)天,氧疗时间:(5.8±3.4)天比(8.1±5.5)天,P<0.05]。但未影响气漏、肺出血、动脉导管未闭、坏死性小肠结肠炎、严重脑室内出血和支气管肺发育不良的发生率以及RDS早产儿的病死率。结论早期给予PS治疗能显著减少RDS早产儿的机械通气时间和氧疗时间。     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

目的 评价经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效.方法 2008年1月至6月,检索PubMed、荷兰医学文摘(Embase)、OVID全文数据库、Cochrane图书馆、中国学术期刊网全文数据库(CNKI)、中国牛物医学文献数据库(CBMdisc),收集NIPPV治疗早产儿RDS的临床试验,进行质量分析,并对符合纳入标准的研究应用Revman4.2软件进行Meta分析.结果 纳入随机对照研究5篇,共284例RDS早产儿,其中在撤除气管插管呼吸机后阶段应用NIPPV与鼻塞持续正压通气(nasal continuous positive airway pressure,NCPAP)的疗效比较共3篇,Meta分析显示NIPPV组拔管失败率低于NCPAP组(8.34%vs 40.79%),差异有统计学意义[RR 0.21(95%CI:0.10～0.45;P<0.001)];3篇研究中2篇进行了支气管肺发育不良(bronchopulmonary dysplasia,BPD)的分析,Meta分析显示NIPPV组BPD患病率较低(39.34%vs 54.39%),但差异无统计学意义[RR 0.73(95%CI:0.49～1.07;P=0.11)];以NIPPV作为初始通气模式2篇,其中与气管插管常规通气(conventional ventilation,cv)模式比较1篇,NIPPV组比CV组BPD患病率低(10%vs 33.33%,P=0.04);与NCPAP比较1篇,NIPPV组比NCPAP组BPD患病率低(2.33%vs 17.07%,P=0.03).结论 NIPPV作为初始通气模式治疗早产儿RDS是可行的,NIPPV组具有较低的BPD患病率.在气管插管呼吸机拔管后阶段应用NIPPV可降低拔管失败率.     

重症新生儿呼吸窘迫综合征患儿吸入一氧化氮后肺血流与氧合动态变化

为探讨吸入一氧化氮（ＮＯ）对早产儿呼吸窘迫综合征（ＲＤＳ）的疗效，对１０例ＲＤＳ患儿进行了吸入ＮＯ治疗，浓度以２０ｐｐｍ开始，４小时后降为６ｐｐｍ，持续至２４小时。同时在吸入前、吸入后３０分钟及吸入后１２～１６小时动态观察平均肺动脉血流速度及体循环氧合变化。结果：吸入ＮＯ后有８例患儿血氧饱和度迅速上升；吸入３０分钟后平均肺动脉血流速度显著增加（Ｐ＜０．０５），氧合指数显著改善（Ｐ＜０．０５）；以６ｐｐｍ浓度维持至２４小时，氧合指数持续改善，肺动脉血流继续增加。提示：吸入ＮＯ能显著降低重症ＲＤＳ患儿的肺血管阻力，改善氧合；采用无创伤性方法测定平均肺动脉血流速度对选择吸入ＮＯ适应证、评价疗效有较大的价值     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.