经鼻持续气道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

目的 探讨经鼻持续气道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效果.方法 <32周的早产儿合并新生儿呼吸窘迫综合征早产儿33例随机分入2组进行对照研究:应用肺表面活性物质后立即拔管继以经鼻持续气道正压通气(S-N组)16例和应用肺表面活性物质后接受机械通气治疗(S-M组)17例.比较2组主要终点和次要终点是否需要机械通气及通气时间,以及其他相关临床特征.结果 生后7 d时,S-N组有1例(6.25%)接受机械通气,S-M组有8例(47.00%)仍不能脱离呼吸机.S-M组与S-N组相比较,用氧时间[(11.4±4.6)d与(7.0±1.9)d]、经鼻持续气道正压通气时间[(6.5±2.9)d与(3.5±2.3)d)]、机械通气时间[(5.9±3.3)d与(2.2±1.2)d]、重症监护室住院时间[(29.9±8.0)d与(21.7±10.1)d]、再次使用肺表面活性物质的概率[(12.5%,2/16)与(53.0%,9/17)],S-M组均显著高于S-N组,差异有统计学意义(P均<0.05).结论 应用肺表面活性物质后立即继以经鼻持续气道正压通气有利于新生儿呼吸窘迫综合征的治疗.

Therapeutics of neonatal respiratory distress syndrome with nasal continuous positive airways pressure combined with pulmonary surfactant

Objective To evaluate the clinical effects of nasal continuous positive airway pressure (NC-PAP) and surfactant administration in preterm infants with neonatal respiratory distress syndrome(NRDS) Methods A prospective randomized study was conducted, in which infants <32 weeks' gestation with NRDS were random-ized to the aurfactant-NCPAP (S-N) group or the surfactant-mechanical ventialtion (S-M) group. Results At 7 days after birth, 1 infant (6.25%) in the S-N group and 8 infants (47.00%) in the S-M group were still undergo-ing mechanical ventilation. The duration of oxygen therapy, NCPAP and mechanical ventilation,the need for a sec-ond dose of surfactant, and the days of staying in the intensive care unit were significantly greater in the S-M group. Conclusions The immediate application of NCPAP after surfactant administration for infants with NRDS is safe and beneficial.