肺表面活性物质联合俯卧位机械通气治疗NRDS的临床研究

目的研究肺表面活性物质(PS)联合俯卧位机械通气(PPV)治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法将收入该科行机械通气的NRDS患儿分成三组,家属同意用PS替代疗法的患儿为治疗1组,除外治疗1组患儿按上机先后顺序奇数分为治疗2组,偶数分为对照组;治疗1组采用PS联合PPV,治疗2组仅采用PPV;对照组仅采用仰卧位机械通气。三组患儿其他治疗方法相同,均采用多功能监护仪监护。分别在机械通气前,机械通气30 min,6、24 h监测患儿血气分析,了解患儿动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)的情况,以及各阶段呼吸机的平均气道压(MAP)、吸入氧浓度(FiO2)指数,详细记录患儿用机时间、平均住院时间、并发症呼吸机相关性肺炎(VAP)]和预后机械通气所致肺损伤(VILI)]情况。结果三组患儿治疗后各时间点血气分析、呼吸机指数与治疗前比较,差异有统计学意义(P<0.05);治疗2组与对照组比较:治疗开始24 h后,差异有统计学意义(P<0.05),治疗开始后24 h内,差异无统计学意义(P>0.05);治疗1组与对照组比较,差异有统计学意义(P<0.01)。治疗2组用机时间、平均住院时间、并发症、预后与对照组比较,差异有统计学意义(P<0.05),治疗1组与对照组比较,差异有统计学意义(P<0.01)。结论机械通气能有效治疗NRDS,PPV优于仰卧位机械通气,PS联合PPV治疗NRDS,能有效缩短呼吸机使用时间,减少机械通气并发症,提高NRDS患儿的存活率,改善预后。

Clinical research on pulmonary surfactant combined with prone position mechanical ventilation for treating NRDS

Objective To study using the pulmonary surfactant（PS） combined with prone position mechanical ventilation（PPV） to treat neonatal respiratory distress syndrome（NRDS）for shortening the ventilator use time,reducing mechanical ventilation induced complications,increasing the survival rate of NRDS and improving the prognosis.Methods The NRDS neonates treated by mechanical ventilation in the neonatology department of our hospital were divided into three groups,the treatment group 1,in which the family members agreed with the PS replacement therapy,after excluding the patients in the treatment group 1,the othe patients were assigned to the treatment group 2 for odd number and the control group for even number according to the order of conducting mechanical ventilation.The treatment group 1 adopted PS combined PPV,the treatment group 2 used only PPVand the control group used only mechanical ventilation in the supine position.The other treatment in the three groups was same and the multi-function monitor was adopted for monitoring.Blood gas analysis was performed before ventilation,at 30 min,6 h,24 h,PaO2,PaCO2,MAP and FiO2 index in various stages were detected.The ventilation time,average length of stay,complications,ventilator-associated pneumonia（VAP）,prognosis and ventilator-induced lung injury（VILI） were recorded in detail.Results The comparison in various stages before and after treatment showed statistical difference among 3 groups（P0.05）.The comparison between the treatment group 1 and the control group had statistical difference（P〈0.01）.In the ventilation time,the average length of stay,complications and prognosis,comparing the treatment group 2 with the control group had statistical difference（P〈0.05） and the comparing the treatment group 1 with the control group also showed statistically difference（P〈0.01）.Conclusion Mechanical ventilation can treat NRDS effectively,PPV is superior to supine mechanical ventilation,PS combined PPV in the treatment NRDS can effectively shorten the time of ventilator use,reduce mechanical ventilation induced complications and improve survival rate of NRDS and improve prognosis.