肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

肺表面活性物质替代治疗与支气管肺发育不良的关系

Objective To explore, the effect of different dosage of pulmonary surfactant (PS) on the inci-dence of bronchopulmanary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS: low-dose group (L-PS group, ≤ 100 mg/kg, n =188) ,high-dose group(H-PS group, > 100 mg/kg, n = 94) and no-PS group (N-PS group, n = 121). The frac-tional inspired oxygen(FiO2) and ptlmonary oxygenating function before and after 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubafion, length of hospi-talization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administra-tion, the FiO2,oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased (P <0.05), while PO2 and the arterio-alveolar partial pressure of oxygen were significantly increased (P <0.05)in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups,the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pul-monary oxygenation and prevent the development of BPD, especially in high-dose.     

极低出生体质量儿支气管肺发育不良的临床研究

目的研究极低出生体质量儿中支气管肺发育不良(BPD)的发生率、危险因素、临床特点。方法以2011年9月至2014年12月收治的极低出生体质量儿为研究对象,根据BPD发生与否及严重程度分组,进行回顾性分析。结果极低出生体质量儿中BPD的发生率为17.5%,BPD组胎龄、出生体质量、Apgar评分均低于非BPD组,住院时间显著延长(P0.05);母亲妊娠高血压、新生儿呼吸窘迫综合征(NRDS)、痰培养阳性、肺出血、呼吸暂停、呼吸衰竭及败血症的发生率,两组间进行比较差异有统计学意义(P0.05);BPD组肺泡表面活性物质、氧疗及机械通气的使用率显著高于非BPD组(P0.05)。Logistic回归分析显示胎龄(OR=0.474,P=0.004)、NRDS(OR=5.942,P=0.043)是BPD发生的独立危险因素。痰培养阳性次数与BPD严重程度正相关(r=0.423,P0.01)。BPD组与非BPD组比较,累计用氧时间及累计机械通气时间在第1周、前2周、前3周、前4周差异均有统计学意义(P0.05)。轻度BPD组与中重度BPD组比较,累计机械通气时间在上述时间段差异均有统计学意义(P0.01)。结论 BPD是极低出生体质量儿的常见并发症,常发生于胎龄低于32周的早产儿;低胎龄是BPD发生的独立危险因素;肺部感染严重程度与发生BPD的严重程度相关;BPD组患儿在生后前几周即表现为氧依赖。     

早产儿呼吸衰竭同步机械通气治疗的呼吸力学评价

目的　探讨同步间歇性指令通气 (SIMV )在早产儿机械通气中的临床意义。方法　 4 2例机械通气的早产儿随机分成两组 ,SIMV组 2 4例 ,间歇性指令通气 (IMV)组 18例 ,观察两组呼吸机参数、呼吸力学参数变化 ,以及并发症的发生率及镇静剂的使用次数。结果　上机 2 h后吸气峰压 (PIP)、呼气潮气量 (VTexp)、呼吸系统顺应性 (Crs)、气道阻力 (Raw) ,12 h后吸氧浓度 (Fi O2 ) SIMV组均明显优于 IMV组 ,2 4 h氧合指数(OI) SIMV组明显少于 IMV组 ;镇静剂的使用次数 SIMV组少于 IMV组 ,两组差异均有显著性 (P<0 .0 5或P<0 .0 1) ;并发症的发生率两组差异无显著性 (P均 >0 .0 5 )。结论　早产儿呼吸衰竭机械通气时使用 SIMV模式较 IMV能更快降低 Fi O2 、PIP、OI,较快改善肺功能 ,减少镇静剂和肌松剂的使用率。     

早产儿预防性使用肺表面活性物质的临床观察

目的分析胎龄≤30周的早产儿预防性使用肺表面活性物质（PS）对临床结局的影响。方法将本院收治的31例（最终纳入25例）胎龄≤30周的早产儿纳入观察组,生后30min内即予气管内滴入PS,并使用经鼻持续气道正压通气维持等待转运;将同期同级别同地区的另一家医院转运至同一家医院的52例（最终纳入40例）胎龄≤30周的早产儿纳入对照组,转运前未使用PS,入院后根据病情需要作为治疗性使用PS。比较2组早产儿出院前临床结局的差异。结果2组早产儿呼吸窘迫综合征（RDS）和支气管肺发育不良（BPD）的患病率、机械呼吸使用率、氧疗天数均有显著差异,2组早产儿的死亡率、早产儿视网膜病变（ROP）、坏死性小肠结肠炎（NEC）的患病率无显著差异。结论早期预防性使用PS可降低RDS的发生率及机械呼吸的使用率,同时缩短氧疗时间,降低BPD的患病率。     

盐酸氨溴索对行胃癌根治术老年患者全身麻醉机械通气期间呼吸功能的影响

目的观察术前及术中应用盐酸氨溴索对行胃癌根治术老年患者全身麻醉机械通气期间呼吸功能的影响。方法择期全身麻醉下行胃癌根治术老年患者40例,随机分为盐酸氨溴索组和对照组各20例,对照组术前及术中气管插管机械通气后不应用任何药物;盐酸氨溴索组术前静脉滴注氨溴索1mg/kg,1次/d,连用2d,气管插管机械通气后再给予盐酸氨溴索1mg/kg静脉泵注。手术结束时采集2组动脉血行血气分析,记录pa（O2）、pa（CO2）、肺泡气-动脉血氧分压差（avelar-arterial gradient of oxygen,A-aDO2）,计算pa（O2）/吸入氧浓度（fraction of inspiration O2,FiO2）;术后24h时行床旁X线胸片检查,比较2组肺不张发生情况。结果盐酸氨溴索组pa（O2）、pa（CO2）、A-aDO2、pa（O2）/FiO2分别为（14.36±2.13）、（5.32±0.80）、（3.06±0.80）、（46.68±8.91）kPa;对照组分别为（12.50±0.57）、（5.05±0.57）、（4.39±0.93）、（36.71±5.05）kPa;2组pa（O2）、A-aDO2、pa（O2）/FiO2比较差异有统计学意义（P〈0.05）;对照组发生肺不张6例,盐酸氨溴索组未发生肺不张,2组比较差异有统计学意义（P〈0.05）。结论行胃癌根治术老年患者术前及术中应用盐酸氨溴索可减轻机械通气对肺功能的损害,降低肺不张发生风险。     

持续气管内吹气在急性肺损伤幼猪通气中的作用

目的 观察持续气管内吹气联合保护性低通气压控制通气对内毒素诱导急性肺损伤幼猪的疗效.方法 12只上海小白猪,内毒素60 μg,/ks静脉维持诱导肺损伤.随机(随机数字法)分为单纯机械通气组(MV,n=6)和联合气管内吹气组(TGI,n=6).呼吸机设置参数为吸气峰压10cmH2O(1 cmH2O=0.981 kPa);呼吸末正压2 cmH2O;呼吸频率30次/min,吸气时间0.4 s;流速20 L/min.TGI组经留置婴儿胃管给予2 L/min空气吹入,调节呼吸机吸氧浓度使吸入混合气体所测氧浓度为0.4.记录牛命体征、中心静脉压、通气功能和呼吸力学参数及动脉血气分析.结果 急性肺损伤成模后4 h,与MV组比较,TGI组呼气潮气量、通气效率指数显著升高(P<0.01),平均气道阻压下降(P<0.05).动脉血气分析提示TGI组pH值明显纠正,二氧化碳分压显著下降(P<0.01);同时氧分压、氧合指数显著改善(P<0.05).但两组心率、呼吸频率、动脉压、中心静脉压、肺顺应性和平均气道阻力差异均无统计学意义.组织学检查提示TGI组肺组织炎症程度及出血状况明显减轻.结论 持续气管内吹气可以显著提高急性肺损伤机械通气效率,促进二氧化碳排出,并改善氧合能力,在急性肺损伤治疗中具有一定的应用前景.     

肺表面活性物质治疗急性呼吸窘迫综合征的实验研究

目的：观察外源性肺表面活性物质（ＰＳ）对实验性急性呼吸窘迫综合征（ＡＲＤＳ）的疗效。方法：１８只新西兰白兔油酸诱发ＡＲＤＳ后，９只在机械通气基础上经气道滴入猪ＰＳ（１００ｍｇ／ｋｇ，为ＰＳ组），另外９只给于单纯机械通气作为对照组，均观察４小时。于动物实验的基础状态、治疗前及治疗后１小时、２小时、４小时测定肺功能残气量（ＦＲＣ）、动脉血气和肺泡动脉血氧分压差〔Ｐ（Ａ－ａ）Ｏ２〕。实验结束时观察肺病理形态并测定肺泡容积密度（ＶＶ）。结果：治疗后，对照组ＦＲＣ和动脉血氧分压（ＰａＯ２）／氧浓度（ＦｉＯ２）比值（ＯＩ）呈下降趋势，而ＰＳ组ＦＲＣ和ＯＩ明显高于治疗前和同时间点的对照组（Ｐ＜０．０５或Ｐ＜０．０１），Ｐ（Ａ－ａ）Ｏ２明显低于治疗前和同时间点的对照组（Ｐ＜０．０５或Ｐ＜０．０１）。病理形态观察见对照组广泛性肺不张、肺泡和间质水肿、出血和炎性细胞浸润，ＰＳ组上述改变较轻，ＶＶ增加（Ｐ＜０．０１）。结论：外源性肺表面活性物质对兔油酸型ＡＲＤＳ模型有一定的治疗效果     

膈肌超声在支气管肺发育不良患儿撤机中的应用

目的  探讨应用超声定量新生儿及婴儿的膈肌运动功能以及支气管肺发育不良（BPD）患儿的膈肌运动的变化,评价膈肌超声对BPD机械通气撤机患儿结果的预测价值。方法  纳入2022年8月~2023年8月广州市妇女儿童医疗中心新生儿重症监护室、儿童重症监护室、新生儿外科监护室BPD机械通气患儿23例,再以临床撤机后患儿能否自主呼吸分为撤机成功组（n=18）和失败组（n=5）,记录患儿基本临床特征。同时选取同期本院新生儿及婴儿23例作为正常对照组。应用超声分别测量各组患儿双侧膈肌移动度（DM）、膈肌吸气末厚度（DTinsp）、膈肌呼气末厚度（DTexp）及膈肌增厚率（DTF）。分别比较不同组别左右侧膈肌运动差异。结果  BPD组撤机前、后DM均低于正常对照组,差异有统计学意义（P < 0.05）,DTinsp、DTexp及DTF与对照组比较,差异无统计学意义（P > 0.05）。撤机失败组患儿DM、DTinsp及DTF均低于撤机成功组,差异有统计学意义（P < 0.05）,两组DTexp的差异无统计学意义（P > 0.05）。回顾性撤机前比较,BPD撤机失败组患儿DM、DTF均低于撤机成功组,差异有统计学意义(P < 0.05),两组DTexp、DTinsp差异无统计学意义（P > 0.05)。结论  通过床旁超声评估BPD机械通气患儿的膈运动功能的变化规律,可对其撤机结果有较好的预测价值。     

Effect of high-dose prednisolone on lung fluid in patients with non-cardiogenic lung edema

The influence of high-dose prednisolone on extravascular lung water (EVLW) was studied in a randomized trial in patients with noncardiac pulmonary edema. The patients were treated every 6 hours for 48 hours with 2 g of prednisolone-hemisuccinate or placebo. In the prednisolone-group (n = 7) EVLW decreased from 16.4 +/- 6.2 before to 11.8 +/- 5.1 ml/kg after treatment (p less than 0.05). Additionally alveolar-arterial oxygen gradient (AaDO2/FiO2), pulmonary vascular resistance and heart rate decreased, while arterial oxygen tension (PaO2/FiO2) and mean arterial pressure increased (p less than 0.05). In the placebo-group (n = 7) EVLW increased slightly from 17.5 +/- 3.1 before to 19.3 +/- 10.3 ml/kg after treatment. Additionally all other parameters did not change significantly in this group. Although no statistical significant difference was found between the two groups of treatment, a decrease in EVLW was observed in all prednisolone-treated patients, whereas a pronounced increase in EVLW was found in 3 placebo-treated patients. Probably, those patients would have benefited from high-dose prednisolone treatment. High-dose prednisolone reduced EVLW and improved hemodynamics and gas exchange in patients with noncardiac pulmonary edema, whereas placebo did not achieve comparable effects. Therefore, high-dose prednisolone appears beneficial in noncardiac pulmonary edema in respect of EVLW, hemodynamics, and gas exchange.     

有创机械通气-高流量氧疗序贯治疗慢性阻塞性肺疾病所致急性呼吸衰竭的临床研究

目的评价有创机械通气-经鼻高流量氧疗（HFNC）序贯性治疗慢性阻塞性肺疾病（COPD）所致急性呼吸衰竭患者的可行性与临床效果。 方法以2017年3月至2018年5月间盐城市第一人民医院重症医学科（ICU）收治的支气管-肺部感染所致COPD急性呼吸衰竭且需有创机械通气的患者为研究对象。出现肺部感染控制窗（PIC）后随机分为有创-无创序贯治疗组（NIV组）和有创-高流量氧疗序贯治疗组（HFNC组）。观察2组患者一般资料以及急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、全身性感染相关性功能衰竭评分（SOFA）、临床肺部感染评分（CPIS）;出窗时全身炎症性指标、呼吸力学指标;出窗时及序贯治疗2 h后呼吸、循环指标;48 h再插管率、面部压力性损伤发生率、住ICU时间、住院病死率。 结果（1）共纳入73例患者,其中NIV组38例,HFNC组35例。2组患者入组时一般资料以及APACHE Ⅱ、SOFA、CPIS等评分比较,差异无统计学意义（P>0.05）。（2）2组患者出窗时间及出窗时体温（T）、白细胞计数（WBC）、降钙素原（PCT）、超敏C反应蛋白（hs-CRP）、平均动脉血压（MAP）、心率（HR）、乳酸（Lac）、呼吸频率（RR）、氧分压（PaO₂）、二氧化碳分压（PaCO₂）、氧合指数（P/F）、呼吸舒适度评分、气道阻力（R）、静态肺顺应性（Cstat）、静态内源性呼气末正压（PEEPi-stat）等指标比较,差异均无统计学意义（P>0.05）。（3）与NIV组比较,HFNC组序贯治疗2 h后HR、RR、PaCO₂显著下降［（85.42±11.80）次/min vs （99.38±11.01）次/min,t=3.717,P=0.001;（21.26±5.23）次/min vs （26.88±9.26）次/min,t=2.254,P=0.033;（48.14±5.51）mmHg vs （51.48±4.32）mmHg,t=2.057,P=0.047］,舒适度评分显著升高［（3.92±0.79）分vs（1.83±0.57）分,t=-7.358,P=0.000］。序贯治疗期间HFNC组面部压力性损伤发生率明显于低NIV组（0 vs 21.05%,χ²=8.275,P=0.004）。2组患者脱机后48 h再插管率、患者住ICU时间以及住院病死率比较,差异均无统计学意义（P>0.05）。 结论有创机械通气-HFNC序贯性治疗在改善与维持氧合、48 h再插管率、ICU住院时间、住院病死率等方面与有创-无创序贯方式相当,而且在降低PaCO₂、避免面部压力性损伤发生、提高舒适度等方面有显著的优势。     

肺表面活性物质预防早产儿呼吸窘迫综合征的疗效评价

目的评价肺表面活性物质（pulmonary surfactant,PS）预防早产儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS）的疗效。方法95例胎龄为28～34周早产儿,均给予保暖、通畅呼吸道、吸氧、呼吸机辅助呼吸、控制感染、防治出血等常规治疗的基础上,按照家长对PS的使用意见分为两组。观察治疗组45例,出现典型临床表现确诊为NRDS后使用PS,若未出现典型临床表现,则不使用PS;预防使用组50例,全部在出生后30分钟内,无论有无NRDS的临床表现均使用PS。比较两组患儿NRDS发生率、胸部X射线、辅助呼吸时间、并发症率和病死率。结果预防使用组的NRDS发生率（38．00％）明显低于观察治疗组（75．56％）,确诊病例较观察治疗组的胸片分级低,辅助呼吸时间短,差异均有统计学意义（P〈0．05）。两组并发症发生率及病死率差异无统计学意义（P〉0．05）。结论与观察确诊后才使用PS相比,早期预防使用PS能够减少NRDS的发生率,降低胸片分级,缩短辅助呼吸时间。