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目的:评价气管插管-肺表面活性物质-拔管(intubation-surfactant-extubation,In Sur E)治疗策略在新生儿呼吸窘迫综合征(NRDS)中的临床应用优势。方法:按照入院顺序将80例NRDS早产儿随机分成观察组和对照组各40例,观察组采用In Sur E策略治疗,对照组采用早期气管插管肺泡表面活性物质干预后常频通气(CMV)治疗,比较两组患儿治疗前后血气变化、上机时间、住院时间、并发症及转归情况。结果:治疗前两组患儿血气分析及氧合指数比较差异无统计学意义(P>0.05)。治疗后两组患儿的血气指标及氧合指数均明显改善,但观察组较对照组改善更为明显,差异有统计学意义(P<0.05)。观察组住院时间短于对照组,差异有统计学意义(P<0.05)。观察组患儿呼吸机相关性肺炎发生率均明显低于对照组,差异均有统计学意义(P<0.05)。两组患儿上机时间、颅内出血、坏死性小肠结肠炎、支气管肺发育不良及早产儿视网膜病的发生率比较差异无统计学意义(P>0.05)。结论:In Sur E策略能明显改善NRDS患儿的临床严重程度,迅速改善患儿的呼吸功能,显著减少呼吸机相关性肺炎的发生,缩短住院时间,值得推广应用。
PURPOSE: To evaluate the clinical utility of intubation-surfactant-extubation (In Sur E) in neonatal respiratory distress syndrome (NRDS). Methods: Eighty preterm infants with NRDS were randomly divided into observation group (40 cases) and control group (40 cases). The observation group was treated with In Sur E strategy. The control group was treated by early tracheal intubation with alveolar surfactant (CMV) Treatment, blood gas changes before and after treatment in both groups were compared, the time on board, hospital stay, complications and outcome. Results: There was no significant difference in blood gas analysis and oxygenation index between the two groups before treatment (P> 0.05). After treatment, the blood gas indexes and oxygenation index of both groups were significantly improved, but the observation group improved more obviously than the control group, the difference was statistically significant (P <0.05). The length of stay in observation group was shorter than that in control group, with significant difference (P <0.05). The incidence of ventilator-associated pneumonia in the observation group was significantly lower than that in the control group, with statistical significance (P <0.05). There was no significant difference in the incidence of PCOS, intracranial hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and retinopathy of prematurity between the two groups (P> 0.05). Conclusion: In Sur E strategy can significantly improve the clinical severity of children with NRDS, rapidly improve respiratory function, significantly reduce the incidence of ventilator-associated pneumonia and shorten the hospital stay, which is worth popularizing and applying.