不同通气方式联合肺表面活性物质治疗新生儿呼吸窘迫综合征的效果评价

目的：探讨不同通气方式联合肺表面活性物质治疗新生儿呼吸窘迫综合征的有效性及临床价值。方法选择本院2010年1月~2013年1月收治入院的呼吸窘迫综合征新生儿230例，随机分为观察组和对照组各115例，观察组采用鼻塞持续气道正压通气结合肺表面活性物质治疗，对照组采用常规机械通气结合肺表面活性物质治疗，比较两组患儿的临床治疗效果及不良反应情况。结果观察组应用肺表面活性物质后2~3h皮肤颜色转红，经皮血氧饱和度逐渐升高。6 h后动脉血氧分压（PaO2）、动脉/肺泡血氧分压比值（a/A PO2）明显上升，氧合指数（OI）逐渐降低，与治疗前比较，差异有统计学意义（P〈0.05）；治疗后两组间PaO2、a/A PO2、OI比较，差异有统计学意义（P〈0.05）。观察组治疗后吸入氧浓度（FiO2）及呼气末正压（PEEP）逐渐降低，与治疗前比较，差异有统计学意义（P〈0.05）；治疗后两组FiO2比较，差异有统计学意义（P〈0.05），PEEP比较，差异无统计学意义（P〉0.05）。结论鼻塞持续气道正压通气结合肺表面活性物质能有效改善新生儿呼吸窘迫综合征患儿肺顺应性及氧合功能，降低不良反应发生率，适合在临床上推广应用。

Effect evaluation of different modes of ventilation combined with pul-monary surfactant in treatment of neonatal respiratory distress syndrome

Objective To investigate the effective and clinical value of different modes of ventilation combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome （NRDS）. Methods 230 cases of neonatal respiratory distress syndrome in our hospital from January 2010 to January 2013 were selected,and were randomly di-vided into observation group and control group,115 cases in each group,the observation group were treated with nasal continuous positive airway pressure ventilation combined with pulmonary surfactant treatment,the control group were treated with conventional mechanical ventilation therapy combined with pulmonary surfactant,and the clinical therapeu-tic effect and adverse reactions were compared between the two groups. Results In the observation group,after the ap-plication of pulmonary surfactant 2 to 3 hours,skin color changed to red,transcutaneous oxygen saturation increased gradually,after 6 hours,arterial partial pressure of oxygen （PaO2）,arterial / alveolar oxygen partial pressure ratio （a/A PO2） were increased significantly,and the oxygenation index （OI） was decreased,there was significant difference com-pared with that before treatment （P〈0.05）;and the two groups had significant difference after treatment about PaO2,a/A PO2 and OI （P〈0.05）.After treatment,the inspired oxygen concentration （FiO2） and positive end-expiratory pressure （PEEP） of two groups were decreased,there was significant difference compared with that before treatment （P〈0.05）;and the two groups had significant difference after treatment （P〈0.05）. Conclusion Nasal continuous positive airway pressure ventilation combined with pulmonary surfactant can effectively improve lung compliance and oxygenation function in children with neonatal respiratory distress syndrome,reduce the incidence of adverse reaction,is suitable for use in clinic.