LISA技术与INSURE技术分别联合NCPAP治疗新生儿呼吸窘迫综合征的效果比较
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摘要
目的:比较经胃管微创注入肺表面活性物质(LISA)技术与经气管插管注入肺表面活性物质(INSURE)技术分别联合经鼻持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(RDS)的效果。方法:选取2016年1月-2018年1月本院收治的RDS患儿74例。按照随机数字表法将其分为A、B组,各37例。A组予以患儿LISA联合NCPAP治疗,B组给予患儿INSURE联合NCPAP治疗。比较两组患儿的并发症、死亡率、心动过缓、脉搏血氧饱和度(SpO_2)下降、再次使用PS率以及72 h机械通气率等指标情况。结果:A组患儿注入PS均成功,B组出现1例患儿需要二次置管;A组心动过缓、脉搏SpO_2下降、72 h机械通气率均低于B组,比较差异均有统计学意义(P<0.05);两组再次使用PS率、死亡率、早产儿视网膜病变、气胸、颅内出血、坏死性小肠结肠炎发生率比较,差异均无统计学意义(P>0.05);A组支气管肺发育不良发生率低于B组,比较差异有统计学意义(P<0.05)。结论:与INSURE技术比较,LISA技术治疗RDS效果更加明显,可以作为安全有效的给药途径在临床推广使用。
Objective:To compare the efficacy of transnasal continuous positive airway pressure ventilation(NCPAP)in treatment of neonatal respiratory distress syndrome(RDS)by minimally invasive injection of pulmonary surfactant(LISA)via gastric tube and by infusion of pulmonary surfactant(INSURE)via tracheal intubation.Method:A total of 74 RDS children admitted to our hospital from January 2016 to January 2018 were selected.According to the random number table method,they were divided into A group and B group,37 cases in each group.A group was treated with LISA and NCPAP,while B group was treated with INSURE and NCPAP.The complications,mortality,bradycardia,decreased SpO_2,re-use of PS and 72-hour mechanical ventilation between two groups were compared.Result:The PS was injected successfully in A group,and 1 patient needed two catheterization in B group,the bradycardia,decreased SpO_2 and 72 h mechanical ventilation rate in A group were lower than those of B group,the differences were statistically significant(P<0.05).The rates of re-use of PS,mortality,retinopathy of premature infants,pneumothorax,intracranial hemorrhage and necrotizing enterocolitis in two groups were compared,the differences were not statistically significant(P>0.05).The incidence of bronchopulmonary dysplasia in A group was lower than that of B group(P<0.05).Conclusion:Compared with the INSURE technology,LISA technology is more effective in treatment of RDS,which can be used as a safe and effective way of drug administration in clinical promotion.
Objective:To compare the efficacy of transnasal continuous positive airway pressure ventilation(NCPAP)in treatment of neonatal respiratory distress syndrome(RDS)by minimally invasive injection of pulmonary surfactant(LISA)via gastric tube and by infusion of pulmonary surfactant(INSURE)via tracheal intubation.Method:A total of 74 RDS children admitted to our hospital from January 2016 to January 2018 were selected.According to the random number table method,they were divided into A group and B group,37 cases in each group.A group was treated with LISA and NCPAP,while B group was treated with INSURE and NCPAP.The complications,mortality,bradycardia,decreased SpO_2,re-use of PS and 72-hour mechanical ventilation between two groups were compared.Result:The PS was injected successfully in A group,and 1 patient needed two catheterization in B group,the bradycardia,decreased SpO_2 and 72 h mechanical ventilation rate in A group were lower than those of B group,the differences were statistically significant(P<0.05).The rates of re-use of PS,mortality,retinopathy of premature infants,pneumothorax,intracranial hemorrhage and necrotizing enterocolitis in two groups were compared,the differences were not statistically significant(P>0.05).The incidence of bronchopulmonary dysplasia in A group was lower than that of B group(P<0.05).Conclusion:Compared with the INSURE technology,LISA technology is more effective in treatment of RDS,which can be used as a safe and effective way of drug administration in clinical promotion.
引文
[1]徐嘉莉,钟晓云.肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效观察[J].儿科药学杂志,2015,21(10):18-20.
[2]孙祎璠.新生儿呼吸窘迫综合征无创通气治疗的研究进展[J].国际儿科学杂志,2016,43(10):803-806.
[3]邰海服,张士发,茅双根,等.两种机械通气模式治疗新生儿呼吸窘迫综合征的效果比较[J].广东医学,2015,36(19):3018-3021.
[4]Cummings J J,Polin R A.Noninvasive Respiratory Support[J].Pediatrics,2016,137(1):1-11.
[5]Polin R A,Carlo W A.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.
[6]李婷,姜红,刘冬云,等.InSure技术治疗极早产儿呼吸窘迫综合征失败的高危因素分析[J].中国当代儿科杂志,2014,16(6):610-613.
[7]李建业,刘伟,张彦伦.INSURE策略与机械通气治疗新生儿呼吸窘迫综合征疗效对照分析[J].中国医师杂志,2016,18(2):273-275.
[8]霍志艳.NCPAP序贯高流量鼻导管湿化氧疗治疗新生儿呼吸窘迫综合征临床研究[J].临床医学研究与实践,2016,1(19):107,115.
[9]王昌燕,裴怀腾,余晓娟.不同剂量PS治疗新生儿呼吸窘迫综合征的临床研究[J].中国妇幼健康研究,2015,26(2):264-268.
[10]龚兆荣,王艳丽,陈运彬,等.不同机械通气方式治疗重症新生儿呼吸窘迫综合征近远期效果观察[J].中国新生儿科杂志,2015,30(4):277-281.
[11]卢国庆,龚爱兰.新生儿呼吸窘迫综合征57例临床分析[J].临床医学研究与实践,2016,1(5):30.
[12]李梅君,张红.PS联合NCPAP在新生儿呼吸窘迫综合征治疗中的价值[J].大理学院学报,2016,1(2):38-40.
[13]苏小红.新生儿呼吸窘迫综合征不间断NCPAP通气下应用固尔苏的疗效及护理[J].海峡药学,2016,28(11):201-202.
[14]张丽华,薛莲,王娟.nCPAP联合肺表面活性物质治疗早产儿呼吸窘迫综合征的护理[J].中国伤残医学,2014,22(16):208-209.
[15]王红霞,徐心坦,张晓慧.不同时机应用经鼻持续气道正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效观察[J].中国妇幼保健,2017,32(7):1565-1568.
[16]王力伟.PS联合NCPAP治疗新生儿呼吸窘迫综合症疗效观察[J].航空航天医学杂志,2015,26(11):1371-1373.
[17]马晓蕾.NCPAP治疗早产儿呼吸窘迫综合征的综合疗效及对血气指标和肺部感染率的影响[J].河北医学,2015,21(9):1426-1429.
[18]邓伟驰.经鼻双水平正压通气联合Insure技术治疗早产儿呼吸窘迫综合征的临床研究[J].白求恩医学杂志,2016,14(1):101-103.
[2]孙祎璠.新生儿呼吸窘迫综合征无创通气治疗的研究进展[J].国际儿科学杂志,2016,43(10):803-806.
[3]邰海服,张士发,茅双根,等.两种机械通气模式治疗新生儿呼吸窘迫综合征的效果比较[J].广东医学,2015,36(19):3018-3021.
[4]Cummings J J,Polin R A.Noninvasive Respiratory Support[J].Pediatrics,2016,137(1):1-11.
[5]Polin R A,Carlo W A.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.
[6]李婷,姜红,刘冬云,等.InSure技术治疗极早产儿呼吸窘迫综合征失败的高危因素分析[J].中国当代儿科杂志,2014,16(6):610-613.
[7]李建业,刘伟,张彦伦.INSURE策略与机械通气治疗新生儿呼吸窘迫综合征疗效对照分析[J].中国医师杂志,2016,18(2):273-275.
[8]霍志艳.NCPAP序贯高流量鼻导管湿化氧疗治疗新生儿呼吸窘迫综合征临床研究[J].临床医学研究与实践,2016,1(19):107,115.
[9]王昌燕,裴怀腾,余晓娟.不同剂量PS治疗新生儿呼吸窘迫综合征的临床研究[J].中国妇幼健康研究,2015,26(2):264-268.
[10]龚兆荣,王艳丽,陈运彬,等.不同机械通气方式治疗重症新生儿呼吸窘迫综合征近远期效果观察[J].中国新生儿科杂志,2015,30(4):277-281.
[11]卢国庆,龚爱兰.新生儿呼吸窘迫综合征57例临床分析[J].临床医学研究与实践,2016,1(5):30.
[12]李梅君,张红.PS联合NCPAP在新生儿呼吸窘迫综合征治疗中的价值[J].大理学院学报,2016,1(2):38-40.
[13]苏小红.新生儿呼吸窘迫综合征不间断NCPAP通气下应用固尔苏的疗效及护理[J].海峡药学,2016,28(11):201-202.
[14]张丽华,薛莲,王娟.nCPAP联合肺表面活性物质治疗早产儿呼吸窘迫综合征的护理[J].中国伤残医学,2014,22(16):208-209.
[15]王红霞,徐心坦,张晓慧.不同时机应用经鼻持续气道正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效观察[J].中国妇幼保健,2017,32(7):1565-1568.
[16]王力伟.PS联合NCPAP治疗新生儿呼吸窘迫综合症疗效观察[J].航空航天医学杂志,2015,26(11):1371-1373.
[17]马晓蕾.NCPAP治疗早产儿呼吸窘迫综合征的综合疗效及对血气指标和肺部感染率的影响[J].河北医学,2015,21(9):1426-1429.
[18]邓伟驰.经鼻双水平正压通气联合Insure技术治疗早产儿呼吸窘迫综合征的临床研究[J].白求恩医学杂志,2016,14(1):101-103.