鼻腔持续与间歇正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效

摘要]目的：探究鼻腔持续正压通气（NCPAP）与间歇气道正压通气（NIPPV）联合肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征（NRDS）早产儿的疗效及其预后。方法：选取2016年1月至2018年1月间于我院就诊的158例NRDS患儿，随机分为对照组79例和观察组79例，在牛肺磷脂治疗基础上分别行NCPAP和NIPPV无创通气，院外随访30 d，比较两组患儿治疗前后各血气指标PaO2、PaCO2、pH、PaO2/FiO2（P/F值）、并发症发生情况、临床疗效以及近期预后。结果：治疗后6 h、24 h、48 h两组患儿PaCO2显著低于治疗前，PaO2、pH以及P/F值显著高于治疗前（P<0.05），其中观察组PaCO2显著低于对照组（P<0.05），其余指标显著高于对照组（P<0.05）；观察组患儿机械通气例数、有创辅助通气时间、无创辅助通气时间、总氧疗时间、住院时间和治疗后并发症发生率显著低于对照组（P<0.05）；观察组治疗总有效率89.87%，显著高于对照组的77.22%（P<0.05)；两组患儿的生存率比较差异无统计学意义HR=0.482，95%CI（0.175，1.326），P=0.173]。结论：NIPPV联合PS治疗NRDS，可以显著提高临床疗效，改善患儿血气指标，改善氧合功能，缩短治疗时间，且安全性较高。

Efficacy of Nasal Continuous and Intermittent Positive Airway Pressure Ventilation Combined with Pulmonary Surfactant in the Treatment of Neonatal Respiratory Distress Syndrome

Abstract] Objective: To probe into the efficacy and prognosis of nasal continuous positive airway pressure ventilation (NCPAP) and nasal intermittent positive airway pressure ventilation (NIPPV) combined with pulmonary surfactant (PS) in the treatment of premature infants with neonatal respiratory distress syndrome (NRDS). Methods: Totally 158 children with NRDS admitted into our hospital from Jan. 2016 to Jan. 2018 were extracted to be randomly divided into the control group and the observation group, with 79 cases in each group. Two groups were respectively given NCPAP and NIPPV non-invasive ventilation on the basis of porcine lung phospholipid therapy, and were followed up for 30 d after discharge. The blood gas indexes such as PaO2, PaCO2, pH, PaO2/FiO2 (P/F), complications, clinical efficacy and short-term prognosis of two groups were compared. Results: At 6 h, 24 h and 48 h after treatment, PaCO2 was significantly lower than that before treatment, and the values of PaO2, pH and P/F were significantly higher than those before treatment (P<0.05). PaCO2 in the observation group was significantly lower than that in the control group (P<0.05), and other indicators were significantly higher than that in the control group (P<0.05). The number of cases of mechanical ventilation, invasive assisted ventilation time, non-invasive assisted ventilation time, total oxygen therapy time, length of stay and incidence of complications after treatment in the observation group were significantly lower than those in the control group (P<0.05). The total effective rate in the observation group was 89.87%, significantly higher than 77.22% in the control group (P<0.05). There was no significant difference in the survival rate between two groups (HR=0.482, 95%CI: from 0.175 to 1.326, P=0.173). Conclusion: NIPPV combined with PS in the treatment of NRDS can significantly improve the clinical efficacy, the blood gas index and oxygenation function, shorten the treatment time, with higher safety.