鼻塞式持续气道正压通气联合肺表面活性物质治疗早产儿肺透明膜病对照研究

目的探讨鼻塞式持续气道正压通气(NCPAP)联合肺表面活性物质(PS)和NCPAP联合沐舒坦(MU)两种方法治疗早产儿肺透明膜病的疗效差异。方法将90例肺透明膜病(HMD)早产儿随机分为NCPAP联合PS(NC+PS治疗组)和NCPAP联合MU(NC+MU治疗组),分别进行治疗,并比较两组的疗效、动脉血气分析和近远期并发症的差异。结果 (NC+PS)组的总有效率显著高于(NC+MU)组,而在呼吸困难缓解时间、上呼吸机时间和平均住院时间方面均小于(NC+MU)组,两组间的差异具有统计学意义(P<0.05)。治疗前两组早产儿的pH、PaO2、PaCO2和PaO2/FiO2无统计学差异(P>0.05);治疗后,两组早产儿的pH、PaO2和PaO2/FiO2均逐渐升高,PaCO2逐渐降低,两组间的差异具有统计学意义(P<0.05)。近期并发症主要为肺炎、颅内出血和肺出血,远期并发症主要为脑性瘫痪、听力障碍和早产儿视网膜病,(NC+PS)组的早产儿在早期和远期并发症方面均显著低于(NC+MU)组(P<0.05)。结论 NCPAP联合PS能显著提高早产儿肺透明膜病疗效,近远期并发症低,疗效显著高于NCPAP联合MU的疗效。

Comparative study on nasal continuous positive airway pressure combined with pulmonary surfactant in treatment of premature infants' Hyaline membrane disease

Objective To study the difference in curative effects of nasal continuous positive airway pressure(NCPAP) combined with pulmonary surfactant(PS) and NCPAP combined with Mucosolvan(MU) on premature infants' Hyaline membrane disease(HMD). Methods 90 premature infants with HMD were randomly divided into NCPAP combined with PS(NC+PS treatment) group and MU(NC+MU treatment) group.Curative effects,arterial blood gas,short and long term complications were compared after treatment. Results(NC+PS) group's total effective rate was higher than(NC+MU) group,while the time of dyspnea remission,respirator treatment and mean hospitalization were lower than(NC+MU) group with statistical significance(P<0.05).pH,PaO2,PaCO2 and PaO2/FiO2 before therapy in both groups had no statistical significance(P>0.05).They all increased after treatment except PaCO2,the differences in both group had statistical significance(P<0.05).The main short term complications were pneumonia,intracranial hemorrhage and pulmonary hemorrhage;the main long term complications were cerebral palsy,hearing disorder and retinopathy of prematurity.Comprehensive situation in short and long term complications were significantly better in(NC+PS) group than(NC+MU) group(P<0.05). Conclusion NCPAP combined with PS could significantly promote curative effect on hyaline membrane disease with few short and long term complications.It is significantly better than NCPAP combined with MU.