【作者】 李红梅；

【导师】 岳少杰；

【作者基本信息】 中南大学 ， 临床医学， 2013， 硕士

【摘要】 研究背景：国内外研究已经证实早产儿生后早期应用经鼻持续气道正压通气(nCPAP)和使用肺表面活性物质(PS)防治呼吸窘迫综合征一样有效。目的：探讨≤32周早产呼吸窘迫综合征(RDS)患儿起病后早期使用肺表面活性物质(PS)治疗前应用nCPAP对其疗效的影响。方法：1.回顾性分析本院NICU2009年1月1日至2012年12月31日期间住院的NRDS患儿228例,所有患儿胎龄均<32周,均在生后30分钟内入院,出现呼吸窘迫症状时立即予nCPAP呼吸支持,继之予PS。2.根据使用PS治疗前nCPAP应用时间分为3组：<2h组(n=93)、≥2～<4h组(n=94)、≥4h组(n=41)。3观察指标：PS治疗前后症状体征变化；PS给药前后动脉血气分析变化；用药后3天内需气管插管行机械通气例数、时间；并发症及结局；支气管肺发育不良(BPD)发病率的影响因素分析。4.统计学处理：采用SPSS17.0统计软件,正态分布的计量资料采用单因素方差分析,偏态分布的计量资料采用秩和检验,计数资料比较采用卡方检验,影响因素的检验采用非条件Logistic回归分析。检验水准均为0.05。结果：1.各组患儿PS应用后临床症状、体征均有明显改善。2.三组间用药后与用药前比较,血气改善程度≥2～<4h组相对较明显。3.用药后3天内需气管插管机械通气率,≥2～<4h组最小,有创机械通气时间≥4h组最长,但三组间均无明显统计学差异(p>0.05)。4.<2h组BPD发生率最高,明显高于≥2～<4h组(p<0.05)；病死率、NEC、肺出血、IVH发生率及住院时间各组间无明显统计学差异(p>0.05)；BPD高危因素有胎龄、SGA、多胎,保护因素有PS前nCPAP使用时间。结论：本研究首次发现胎龄小于或等于32周RDS早产患儿起病后立即予经鼻持续气道正压通气(nCPAP)2-4小时可显著提升PS的治疗效果,改善预后,减少机械通气率,减少BPD发病率。但本研究为回顾性临床病例研究,这一现象有待进一步进行前瞻性的研究。更多还原

【Abstract】 Background:Previous studies have confirmed that early prophylatic application of nasal continuous positive airway pressure and pulmonary surfactant have the same effects on preventing neonatal respiratory distress syndrome among the premature infants.Objective:To explore the curative effect of early nasal continuous positive airway pressure on pulmonary surfactant to treat respiratory distress syndrome in preterm infants with gestational age less than or equal to32weeksMethods:1.we retrospectively analyzed228cases of NRDS,who were admited to our NICU award within half an hour after birth and received ealy nCPAP before the use of PS from1st January2009to31st December2012.2.According to the application time of nCPAP given before the use of PS,228preterm infants with RDS were divided into3groups:<2h (n=93)、≥2～<4h(n=94)、4h(n=41). 3.Observation index:the changes of clinical symptoms and physical signs before and after treatment with PS; the changes of arteral blood gas analysis before and after adminstration of PS; the number of cases and the time requiring tracheal intubation and mechanical ventilation within3days after the adminstration of PS; the complications and outcomes;the incidence of BPD and its influencing factors.4.Statistics:Statistical analysis was done using the software SPSS17.0:normal distribution quantitative data with single factor analysis of variance, skewed distribution quantitative data with rank sum test, count data by chi sqare test and the non-conditional Logistic regression analysis was used to analyze the determinants.The test lever is0.05.Results:l.The clinical symptoms and physical signs of most the patients after PS treatment were significantly improved.2.The arteral blood gas analysis were markedly improved after the administration of PS in each group,and the improvement degree was the most in≥2～<4h group.3.In term of the rates of the tracheal intubation and mechanical ventilation within3days after the adminstration of PS,≥2～<4h group was lower than<2h group and≥4h group, and≥4h group was the longest in the duriation times of Mechanical ventilation, but there is no significant difference among the three groups (p>0.05).4.There is no significant difference among the three groups in hospital days (p>0.05).5.The incidences of BPD in≥2～<4h group was the lowest,significantly lower than<2h group (p<0.05). There was no significant difference in the death rates and the incidences of NEC、 pulmonary hemorrhage、intraventricular hemorrhage among the three groups (p>0.05).6. The risk factors of BPD are gestational age、SGA、Multiple birth.The protective fator is the nCPAP used before the PS administration.Conclusion:This study first found that using early nasal continuous positive airway pressure(nCPAP) immediately after the onset of premature infants of≤32weeks’gestational age with RDS for2-4hours and then use the PS,can significantly improve the therapeutic effect of PS,improve prognosis,reduce the mechanical ventilation rate,and reduce the incidence of BPD.更多还原