肺表面活性物质治疗新生儿呼吸窘迫综合征前给予nCPAP呼吸支持最佳时间窗的临床研究被引量：3

Clinical Study on the Optimal Time Window of nCPAP Respiratory Support before Pulmonary Surfactant Treatment for Neonatal Respiratory Distress Syndrome

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摘要目的:探讨肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)前给予经鼻持续气道正压通气(nCPAP)呼吸支持的最佳时间窗。方法:选择2017年1月至2019年12月期间我院收治的NRDS患儿100例。根据随机数字表法分为A组(给予PS前预先进行小于2 h的nCPAP,n=33)、B组(给予PS前预先进行2-4 h的nCPAP,n=33)和C组(立即给予PS,n=34)。对比三组患儿的血气分析指标、肺功能指标、临床指标和并发症发生率。结果:A组、B组给予PS后4h、给予PS后24 h动脉血氧分压(PaO_(2))、pH值高于C组,且B组高于A组(P<0.05),而动脉二氧化碳分压(PaCO_(2))低于C组,且B组低于A组(P<0.05)。A组、B组给予PS后4 h、给予PS后24 h潮气量(VT)、肺动态顺应性(CD)高于C组,且B组高于A组(P<0.05),而吸气阻力(Raw)低于C组,且B组低于A组(P<0.05)。B组用药后3天内需气管插管行机械通气例数少于A组和C组,住院时间短于A组和C组(P<0.05),A组、C组的用药后3天内需气管插管行机械通气例数、住院时间对比无明显差异(P>0.05)。三组患儿并发症发生率未见统计学差异(P>0.05)。结论:给予PS前预先进行2-4h的nCPAP,可较好地改善患儿血气分析指标和肺功能,有助于改善患儿预后。 Objective:To explore the optimal time window of respiratory support with nasal continuous positive airway pressure(nCPAP)before pulmonary surfactant(PS)treatment for neonatal respiratory distress syndrome(NRDS).Methods:100 children with NRDS who were admitted from January 2017 to December 2019 were selected.According to the random number table method,they were divided into group A(nCPAP less than 2 h before PS administration,n=33),group B(nCPAP 2-4 h before PS administration,n=33)and group C(PS administration immediately,n=34).The blood gas analysis indexes,pulmonary function indexes,clinical indexes and complication rate of the three groups were compared.Results:The arterial oxygen partial pressure(PaO_(2))and pH value of the group A and the group B at 4 h after PS administration and 24 h after PS administration were higher than those of the group C,and the group B was higher than the group A(P<0.05).The arterial carbon dioxide partial pressure(PaCO_(2))was lower than that of the group C,and the group B was lower than the group A(P<0.05).The volume tidal(VT)and lung dynamic compliance(CD)of the group A and group B at 4 h after PS administration and 24 h after PS administration were higher than those of the group C,and the group B was higher than the group A(P<0.05),while air way resistance(Raw)was lower than that of the group C,and the group B was lower than the group A(P<0.05).The number of cases requiring endotracheal intubation for mechanical ventilation 3 days after medication of the group B was less than that of the group A and group C,and the length of hospital stay was shorter than that of the group A and group C(P<0.05).There were no significant differences in the number of cases requiring endotracheal intubation for mechanical ventilation 3 days after medication and the length of hospital stay of the group A and group C(P>0.05).There was no significant difference in the incidence of complications of the three groups(P>0.05).Conclusion:The nCPAP for 2-4 h before PS administration can improve the blood gas analysis index and pulmonary function of children,which is helpful to improve the prognosis of children.

作者杨艳岳少杰王团美杨琴祝立平 YANG Yan;YUE Shao-jie;WANG Tuan-mei;YANG Qin;ZHU Li-ping(Department of Neonatology,The Affiliated Changsha Central Hospital,Hengyang Medical School,University of South China,Changsha,Hunan,410004,China;Department of Neonatology,Xiangya Hospital of Central South University,Changsha,Hunan,410008,China)

机构地区南华大学衡阳医学院附属长沙中心医院新生儿科中南大学湘雅医院新生儿科

出处《现代生物医学进展》 CAS 2023年第9期1787-1790,1795,共5页 Progress in Modern Biomedicine

基金湖南省卫计委科研基金项目(A2016012)。

关键词肺表面活性物质新生儿呼吸窘迫综合征经鼻持续气道正压通气呼吸支持时间窗 Pulmonary surfactant Neonatal respiratory distress syndrome Nasal continuous positive airway pressure Respiratory support Timewindow

分类号 R725.6 [医药卫生—儿科] R563.8 [医药卫生—呼吸系统]

作者简介杨艳(1990-),女,硕士,主治医师,主要从事新生儿呼吸系统疾病方向的研究,E-mail:Yangyan998866@126.com。