PS联合双水平持续正压通气治疗NRDS早产儿的临床分析

目的分析肺表面活性物质(PS)联合双水平持续气道正压通气(CPAP)治疗新生儿呼吸窘迫综合征(NRDS)早产儿的效果及对患儿肺氧合、肺泡灌洗液B细胞淋巴瘤基因-2(Bcl-2)、半胱氨酸天冬氨酸蛋白酶-3(Caspase-3)、转化生长因子-β1(TGF-β1)的影响。 方法回顾性分析2016年2月至2019年3月医院新生儿重症监护病房(NICU)收治的99例NRDS早产儿的临床资料，按治疗方式分为A组56例(PS+双水平CPAP)、B组43例(PS+常规CPAP)，比较两组患儿无创呼吸支持不同时间肺氧合功能的变化，记录无创通气时间、氧支持时间、住院时间、PS应用情况、气管插管率及相关并发症发生情况，测定肺泡灌洗液Bcl-2、Caspase-3、TGF-β1表达情况。 结果A组上机12、24 h动脉血二氧化碳分压(PaCO₂)低于B组，上机12 h动脉血氧分压(PaO₂)高于B组，上机12、24、48 h吸入氧浓度(FiO₂)均低于B组，上机12 h氧合指数(OI)高于B组(P<0.05)；A组氧支持时间短于B组，气管插管率、总并发症发生率低于B组(P<0.05)；上机48 h，A组Caspase-3、TGF-β1低于B组，Bcl-2高于B组(P<0.05)。 结论PS联合双水平CPAP治疗NRDS早产儿安全有效，可快速改善患儿肺氧合功能，减轻肺泡炎症及氧化损伤，缩短氧暴露时间，降低呼吸机相关并发症发生风险。

Value of PS combined with bi-level continuous positive airway pressure in the treatment of preterm infants with NRDS

ObjectiveTo analyze curative effect of pulmonary surfactant (PS) combined with bi-level continuous positive airway pressure (CPAP) on preterm infants with neonatal respiratory distress syndrome (NRDS) and their influences on pulmonary oxygenation and expression of B cell lymphoma-2 (Bcl-2), cysteine-asparticacidprotease-3 (Caspase-3) and transforming growth factor-β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF). MethodsThe clinical data of 99 NRDS preterm infants who were admitted to neonatal intensive care unit (NICU) of the hospital from February 2016 to March 2019 were retrospectively collected. According to different treatment methods, they were divided into group A (PS + bi-level CPAP, 56 cases) and group B (PS + routine CPAP, 43 cases). The changes of pulmonary oxygenation function under non-invasive respiratory support for different time were compared between the two groups. The non-invasive ventilation time, oxygen support time, hospitalization time, PS usage, tracheal intubation rate and occurrence of related complications were recorded. The expression of Bcl-2, Caspase-3 and TGF-β1 in BALF was measured. ResultsAfter 12 h and 24 h of starting ventilation, arterial partial pressure of carbon dioxide (PaCO₂) of group A was lower than that of group B. After 12 h of starting ventilation, arterial partial pressure of oxygen (PaO₂) of group A was higher than that of group B. After 12 h, 24 h and 48 h of starting ventilation, fraction of inspired oxygen (FiO₂) in group A was lower than that in group B. After 12 h of starting ventilation, oxygenation index (OI) in group A was higher than that in group B (P<0.05). The oxygen support time of group A was shorter than that of group B, tracheal intubation rate and total incidence of complications were lower than those of group B (P<0.05). After 48 h of starting ventilation, Caspase-3 and TGF-β1 in group A were lower than those in group B, while Bcl-2 was higher than that in group B (P<0.05). ConclusionIt is safe and effective of PS combined with bi-level CPAP in treatment of preterm infants with NRDS. It can rapidly improve pulmonary oxygenation function, alleviate alveolar inflammation and oxidative damage, shorten oxygen exposure time, and reduce risks of ventilator-related complications.