摘要
目的新生儿呼吸窘迫综合征（NRDS）使用肺表面活性物质（PS）后，应用新型鼻塞持续气道正压通气（NCPAP）或常规机械通气（CMv）治疗，比较分析两组的疗效。方法将28例给予PS治疗的NRDS患儿随机分为两组：NCPAP组14例，给药后拔除气管插管，连接NCPAP通气治疗；CMV组14例，给药后继续应用CMV治疗。观察治疗前后两组患儿的血气、X线胸片及并发症情况。结果用药后0．5h，两组患儿PaO2和PaO2／HO2升高，PCO2下降；至6、12、24和72h，PaO2和PaO2／FD2仍明显高于用药前水平，PCO2明显低于用药前水平，差异有非常显著性（P均〈0．01）。两组PaO2、PaO2／FiO2和PCO2差异无显著性（P〉0．05）；NCPAP组用氧时间、住院时间明显短于CMV组，差异有显著性（P〈0．05）；在28d是否需要氧气、肺炎、气胸、支气管肺发育不良和死亡等方面，两组患儿差异无显著性（P〉0．05）。结论PS后给予NCPAP治疗NRDS，能快速有效地改善肺功能，减少机械通气使用率、用氧时间和住院时间。
Objective To compare, after receiving one dose of intratracheally administered suffactant, the outcome of infants with respiratory distress syndrome （RDS） who were extubated to nasal continous positive pressure ventilation （NCPAP） or continued on conventional mechanical ventilation （CMV）. Methods Twenty-eight infants from 29 to 35 weeks of gestation were intubated and given one dose of surfactant. They were then randomized to either continue to conventional mechanical ventilation （CMV group, n = 14） or to be extubated to NCPAP （NCPAP group, n = 14）, observing the change of blood gases, chest X-ray, clinical effects and secondary outcome. Results There were no significant differences in the birth weight, gestational age, gender, Apgar at 5 minutes, age at surfactant instillation, or blood gas prior to surfactant administration, between infants in CMV group and NCPAP group. Half an hour after the administration, PS, PaO2 and PaO2/ FiO2 of the NRDS infants in two groups was increased rapidly. The high levels of PaO2 and PaO2/FiO2 remained till to 6, 12, 24 and 72 hours. There was significant difference compared with those before the treatment （ P 〈 0.01 ）. Half an hour after the drug administration, PCO2 decreased. From then to 72 hours, the level of PCO2 fell and were significantly different from the level before the treatment （P 〈 0.01）. There was no significant difference between the two groups in blood gas postsurfactant（up to 72 hours）. The duration of supplemental oxygen exposure was significantly shorter in the NCPAP group. There was also significant decrease in the hospitalization in this group. There was no signifficant difference in the incidence of intraventricular haemorrhage, air leak, necrotizing enterocolitis, patent ductus arteriosus, retinopathy of prematurity, bronchopulmonary dysplasia or number of infants that died between two groups（P 〉0.05）. Conclusion Infants of from 29 to 35 weeks of gestation with RDS requiring surfactant with early extubation to NCPAP could rapidly and effectively improve the pulmonary oxygenation, and had a shorter duration of oxygen, hospitalization as compared to CMV. NCPAP is a safe and effective primary mode of ventilation in larger premature infants.
出处
《中国小儿急救医学》
CAS
2008年第1期25-29,共5页
Chinese Pediatric Emergency Medicine
关键词
肺表面活性物质
鼻塞持续气道正压
机械通气
新生儿呼吸窘迫综合征
Pulmonary surfactant
Nasal continuous positive airway pressure
Mechanical ventilation
Respiratory distress syndrome, newborn
