鼻塞IMV联合肺表面活性物质治疗早产极低出生体重儿呼吸窘迫综合征临床探究.docVIP

鼻塞IMV联合肺表面活性物质治疗早产极低 出生体重儿呼吸窘迫综合征临床探究 目的：观察鼻塞頂v （鼻塞式呼吸机间歇指令通气 Nasal intermittent mandatory ventilation NIMV）耳关合 肺表面活性物质（PS）治疗早产极低出生体重儿呼吸窘迫综 合征（NRDS）的临床疗效、预后、并发症及住院费用情况， 并与常规机械通气及CPAP比较。方法：NIMV组26例患肺透 明膜病的早产儿经气管内滴入PS （100mg/kg/dose）,然后拔 管，予鼻塞式IMV支持治疗，并与25例常规机械通气及26 例CPAP的患儿进行比较，指标包括患儿的临床症状、体征 及血气变化、并发症、住院时间以及住院费用。结果：治疗 后1小时，患儿症状体征明显好转，6、12及24小时，3组 患儿的血气较治疗前显著改善，3组比较，无明显差异。但 治疗过程中NIMV组的肺部感染及慢性肺疾病的发生率明显 低于机械通气组，且NIMV组的二氧化碳潴留和反复呼吸暂 停的发生率也明显低于常规CPAP组，比起常规机械通气组， 住院费用也较低。结论：应用NIMV治疗早产儿肺透明膜病 即可减少呼吸机相关性肺炎、慢性肺病等并发症，又可治疗 早产儿常发生的反复呼吸暂停，避免二氧化碳潴留，具有治 疗效果好，并发症少、住院时间短，住院费用少等特点。 关键词鼻塞IMV肺表面活性物质CPAP机械通气呼 吸窘迫综合征 doi：10. 3969/j. issn. 1007-614x. 2011.28. 137 AbstractObjective：To evaluate the effect of nasal IMV combined surfactant on neonates with repiratory distress syndrome and compare the effect with conventional IMV and CPAP. Methods：77 babies with severe respiratory syndrome were given curosurf (lOOmg/kg/dose ) , 26 of them were given to nasal IMV, another 25 were given conventional IMV, the last 26 babies were given conventional CPAP.Blood gase,rates of repiratory infection and chronic lung disease,and frequent apnea and carbon dioxide retention,were compare between three groups. Results：arterial partial pressure of oxygen increased, arterial pressure of carbondioxide and oxygen index decreased significantly by the time of 6,12,24 hours after treatment in three groups. There were not significantly difference between three groups, the rates of respiratory infection and chronic lung disease in NIMV group were less than that of conventional IMV group, the rates of frequent apnea and carbon dioxide retention in NIMV group were less than that of CPAP group. Conclusion： surfactant combined nasal IMV is a potential efficient therapy to the babies with severe repiratory distress syndrome,it had lower rates of lung infection and chronic lung disease,it also can treat frequent apnea and avoid carbon dioxide retention. Key WordsNasal IMV pulmonary surfactant respiratory distress syndrome p