预防性经鼻持续气道正压对28～32孕周早产儿透明膜病的影响

目的 探讨早期经鼻持续气道正压(nCPAP)对28～32孕周早产儿肺透明膜病(HMD)的预防作用.方法 54例胎龄28～32周,出生体重小于1 500 g的早产儿在生后30 min内无论有无缺氧均用nCPAP进行呼吸管理,观察HMD的发生率及外源性肺表面活性物质(PS)和机械通气的应用率.结果 观察组HMD的发生率为44%(24/54),明显低于对照组的69%(33/48),P＜0.05,差异有显著性意义,但Ⅲ～Ⅳ级HMD的发生率,两组相比差异无显著性意义,(P＞0.05);观察组30%(16/29)需应用PS,明显少于对照组的50%(24/48),差异有显著性意义P＜0.05;机械通气率及颅内出血的发病率两组相比差异均无显著性意义(P＞0.05).结论 早期nCPAP对28～32孕周早产儿发生HMD有一定的预防作用,能减少外源性PS的应用,但不减少对机械通气的需要.

The effect of prophylactic nasal continuous positive airways pressure on hyaline membrane disease in preterm infants of 28～32 weeks gestation

Objective To explore the prophylactic effect of early nasal continuous positive airways pressure(nCPAP) on hyaline membrane disease(HMD) in preterm infants of 28～32 weeks gestation. Methods Prophylactic nCPAP commenced within 30 minutes after birth regardless of oxygen requirement for respiratory management in 54 cases preterm infants of 28～32 weeks gestation and the birth weights less than 1 500 g,to observe the incidence of HMD and the need for exogenous pulmonary surfactant(PS) and mechanical ventilation as well. Results The incidence of HMD in observed group was significantly lower than that of control group(44% vs 69%,P＜0.05),but the incidence of grade Ⅲ～Ⅳ HMD was not significant difference between the two groups(P＞0.05). However, that the need for exogenous PS in observed group was significantly fewer than in control group(30% vs 50%,P＜0.05),while no significant difference at the incidence of intracranial hemorrhage and the rate of mechanical ventilation were found(P＞0.05).Conclusion The usa of early nCPAP maybe have some benefits as prophylaxis for HMD and reduce the need for exogenous PS,not for mechanical ventilation,in preterm infants of 28～32 weeks gestation.