早产极低出生体重儿早期预防性应用鼻塞式持续气道正压与肺表面活性物质的临床比较

目的:探讨在早产极低出生体重儿中生后早期使用鼻塞式持续气道正压(nCPAP)或应用肺表面活性剂(PS)以预防新生儿呼吸窘迫综合征(NRDS)的临床疗效比较。方法:采用前瞻性对照研究,对出生后早期使用nCPAP辅助通气或早期使用PS替代治疗的早产极低出生体重儿进行对照研究,观察其死亡率、支气管肺发育不良发生率、辅助通气时间及临床并发症。结果:共106例患儿入选,死亡率和支气管肺发育不良(BPD)发生率组间比较差异无统计学意义。机械辅助通气、总用氧时间组间比较差异无统计学意义;nCPAP组PS使用数少于对照组(Odds Ratio:0.37,90%CI 0.209～0.655);气漏发生率低(Odds Ratio:0.476,90%CI 0.233～0.971),IVH发生率低(Odds Ratio:0.778,90%CI 0.319～1.898)。其他临床并发症组间比较差异无统计学意义。结论:早期应用nCPAP是预防早产极低出生体重儿呼吸窘迫综合征另一良好选择。

Clinical comparison of early prophylactic application of nasal continuous positive airway pressure and pulmonary surfactant in the premature very low birth weight infants

Objective:To explore the clinical effects of early prophylactic application of nasal continuous positive airway pressure(nCPAP) and pulmonary surfactant(PS) in prevention of neonatal respiratory distress syndrome(NRDS) among the premature very low birth weight infants.Methods:The clinical effects of early prophylactic application of nCPAP and PS in the premature very low birth weight infants were compared,the death rates,the incidences of bronchopulmonary dysplasia,the duration times of assisted ventilation,and clinical complications in the two groups were observed.Results:A total of 106 infants were enrolled in the study.There was no significant difference in the death rate and the incidence of bronchopulmonary dysplasia between the two groups.There was no significant difference in the duration time of mechanical ventilation and total using oxygen time between the two groups;the number of infants using PS in nCPAP group was fewer than that in control group(Odds ratio: 0.37,90% CI: 0.209-0.655);the incidence of air leakage in nCPAP group was lower than that in control group(Odds ratio: 0.476,90% CI: 0.233-0.971);the incidence of intraventricular hemorrhage(IVH) in nCPAP group was lower than that in control group(Odds ratio: 0.778,90% CI: 0.319-1.898);there was no significant difference in the incidence of the other clinical complications between the two groups.Conclusion:Early application of nCPAP is a good choice for preventing the occurrence of NRDS among the premature very low birth weight infants.