肺表面活性物质联合鼻塞式持续气道正压通气治疗新生儿肺透明膜病的临床效果分析

摘要

目的：分析肺表面活性物质（PS）联合鼻塞式持续气道正压通气（NCPAP）治疗新生儿肺透明膜病的临床效果。方法选取2014年6月—2016年3月咸阳市中心医院新生儿科收治的新生儿肺透明膜病患儿80例，按照入院顺序分为对照组和试验组，每组40例。对照组患儿给予 NCPAP 治疗，试验组患儿给予 PS 联合 NCPAP 治疗。比较两组患儿治疗前后血气分析指标〔动脉血氧分压（ PaO2）、PaO2/吸入氧浓度（ FiO2）及动脉血二氧化碳分压（PaCO2）〕，治疗及住院情况（包括高压力持续时间、高 FiO2持续时间、NCPAP 治疗时间及住院时间），转归情况（包括治愈、再次插管机械通气、死亡、放弃治疗）及并发症情况（气胸、肺炎等）。结果时间与方法在 PaO2、PaO2/ FiO2及 PaCO2上存在交互作用（P <0.05）；时间在 PaO2、PaO2/ FiO2及 PaCO2上主效应显著（P <0.05）；方法在 PaO2、PaO2/ FiO2及 PaCO2上主效应显著（P <0.05）；治疗后1、12、24 h，试验组患儿 PaO2、PaO2/ FiO2均高于对照组，PaCO2均低于对照组（P <0.05）；且两组患儿治疗后1、12、24 h PaO2、PaO2/ FiO2均高于治疗前，PaCO2均低于治疗前（P <0.05）。试验组患儿高压力持续时间、高 FiO2持续时间、NCPAP 治疗时间及住院时间均短于对照组（P<0.05）。试验组患儿治愈率高于对照组，再次插管机械通气者所占比例低于对照组（P <0.05）；两组患儿病死率和放弃治疗率比较，差异无统计学意义（P >0.05）。试验组患儿并发症发生率低于对照组（P <0.05）。结论 PS 联合NCPAP 可有效改善新生儿肺透明膜病患儿血气分析指标，缩短 NCPAP 治疗时间及住院时间，降低再次插管机械通气率和并发症发生率。%Objective To analyze the clinical effect of pulmonary surfactant( PS) combined with nasal continuous positive airway pressure(NCPAP)ventilation on hyaline membrane disease in neonates. Methods From June 2014 to March 2016,a total of 80 neonates with hyaline membrane disease were selected in the Department of Neonatology,the Central Hospital of Xianyang,and they were divided into control group and experiment group according to the order of hospitalization,each of 40 cases. Neonates of control group received NCPAP ventilation,while neonates of experiment group received PS combined with NCPAP ventilation. Blood - gas analysis index( including PaO2 ,PaO2 / FiO2 and PaCO2 ),duration of high breathing machine pressure,high FiO2 and NCPAP ventilation, hospital stays, clinical outcome ( including cure, turned to endotracheal intubation guided respirator assisted ventilation at midway, death, initiative discontinued treatment ) and incidence of complications( including pneumothorax and pneumonia ) were compared between the two groups. Results There was interaction in PaO2 ,PaO2 / FiO2 and PaCO2 between time and method(P < 0. 05);the main effects of time and method were significant in PaO2 ,PaO2 / FiO2 and PaCO2 (P < 0. 05). After 1 hour,12 hours and 24 hours of treatment,PaO2 and PaO2 /FiO2 of experiment group were statistically significantly higher than those of control group,while PaCO2 of experiment group was statistically significantly lower than that of control group,respectively( P < 0. 05);after 1 hour,12 hours and 24 hours of treatment,PaO2 and PaO2 / FiO2 of the two groups were statistically significantly higher than those before treatment,while PaCO2 of the two groups was statistically significantly lower than that before treatment,respectively( P < 0. 05). Duration of high breathing machine pressure,high FiO2 and NCPAP ventilation, and hospital stays of experiment group were statistically significantly shorter than those of control group( P < 0. 05). The cure rate of experiment group was statistically significantly higher than that of control group,while the proportion of neonates turned to endotracheal intubation guided respirator assisted ventilation at midway was statistically significantly lower than that of control group( P < 0. 05);no statistically significant differences of fatality rate or ratio of initiative discontinued treatment was found between the two groups( P > 0. 05). The incidence of complications of experiment group was statistically significantly lower than that of control group( P < 0. 05). Conclusion PS combined with NCPAP ventilation can effectively adjust the blood - gas analysis index,shorten the duration of NCPAP ventilation and hospital stays,reduce the ratio turned to endotracheal intubation guided respirator assisted ventilation at midway and incidence of complications of neonates with hyaline membrane disease.