经鼻间歇正压通气联合牛肺表面活性剂对新生儿呼吸窘迫综合征呼吸力学的影响

Effects of nasal intermittent positive pressure ventilation combined with bovine pulmonary surfactant on respiratory mechanics in neonates with respiratory distress syndrome

摘要:

目的 分析经鼻间歇正压通气联合不同剂量牛肺表面活性剂对新生儿呼吸窘迫综合征（RDS）的应用效果。方法 选取2021年10月—2023年10月在西北妇女儿童医院接受治疗的98例RDS新生儿，采用随机数字表法分为两组，各49例。所有患儿给予经鼻间歇正压通气治疗，对照组在此基础上以60 mg/kg剂量注入牛肺表面活性剂，观察组则以100 mg/kg剂量注入牛肺表面活性剂。记录两组治疗时间，并比较两组治疗前后的血气指标、呼吸力学指标［潮气量、潮气呼气峰流量（PTEF）、每分钟通气量（MV）、达峰时间比］、肺部损伤指标、脑氧代谢［脑氧饱和度（rSO₂）、颈静脉血氧饱和度（SjVO₂）］及并发症发生率。结果 观察组患儿的治疗时间短于对照组（P <0.05），观察组治疗前后的OI、PaO₂、SpO₂、PaCO₂、肺损伤标志物、呼吸力学指标和脑氧代谢指标差值均高于对照组（P <0.05），并发症发生率更低（P <0.05）。结论 高剂量牛肺表面活性剂与经鼻间歇正压通气结合应用有助于改善RDS新生儿的呼吸力学指标，降低并发症发生风险。

Abstract:

Objective To analyze the effects of nasal intermittent positive pressure ventilation (NIPPV) combined with different doses of bovine pulmonary surfactant on neonates with respiratory distress syndrome (RDS).Methods A total of 98 neonates with RDS treated at Northwest Women and Children's Hospital from October 2021 to October 2023 were randomly divided into two groups of 49 cases each. All neonates received NIPPV. In addition, the control group received 60 mg/kg of bovine pulmonary surfactant, while the observation group received 100 mg/kg. Treatment duration, blood gas indices, respiratory mechanics parameters (tidal volume, peak tidal expiratory flow [PTEF], minute ventilation [MV], time to peak ratio), lung injury markers, cerebral oxygen metabolism indices (regional cerebral oxygen saturation [rSO₂], jugular venous oxygen saturation [SjVO₂]), and complication rates were recorded and compared between the two groups.Results The treatment duration in the observation group was significantly shorter than in the control group (P < 0.05). The differences in oxygenation index (OI), partial pressure of oxygen (PaO₂), oxygen saturation (SpO₂), partial pressure of carbon dioxide (PaCO₂), lung injury markers, respiratory mechanics, and cerebral oxygen metabolism indices before and after treatment were significantly greater in the observation group compared to the control group (P < 0.05). The incidence of complications was also lower in the observation group (P < 0.05).Conclusion The combination of high-dose bovine pulmonary surfactant with NIPPV significantly improves respiratory mechanics in neonates with RDS and reduces the risk of complications.