摘要
目的探讨INSURE技术在极低及超低出生体重早产儿呼吸支持中的临床应用价值。方法本研究为回顾性分析。清华大学第一附属医院2010年6月至2012年8月收治的有呼吸闲难且需要呼吸支持的极低及超低出生体重儿83例，依据呼吸支持方法的不同分为INSURE组41例与机械通气组42例。INSURE组患儿生后尽快予以气管插管、气管内滴入肺表面活性物质、拔管后经鼻持续气道正压通气。机械通气组患儿生后予气管插管、气管内用或不用肺表面活性物质、不拔除气管导管直接连接呼吸机辅助通气。卡方检验、两独立样本t检验及秩和检验比较2组患儿治疗后1h、12h动脉血气改善情况，呼吸窘迫综合征、呼吸机相关性肺炎、气漏、慢性肺疾病、颅内出血、视网膜病变、脑白质软化等疾病的发生情况，以及呼吸机使用时间、用氧时间、住院时间、住院费用等。结果（1）组内治疗前后氧合情况比较：INSURE组患儿治疗后1h动脉血氧分压为（78．7±11．5）mm Hg（1mmHg=0．133kPa），高于治疗前[（50．1±10．8）mmHg]，而二氧化碳分压低于治疗前[（48．3±8．9）mmHg与（54．9±11．5）mm Hg]，差异均有统计学意义（t分别为9．737、3．428，P均〈0．05）。机械通气组患儿治疗后1h动脉血氧分压为（80．2±10．0）mm Hg，高于治疗前[（51．3±9．8）mmHg]，而二氧化碳分压低于治疗前[（45．6±9．5）mmHg与（57．1±12．8）n]mgHg]，差异均有统计学意义（t分别为10．093、-4．526，P均〈0．05）。（2）组间氧合情况比较：INSURE组与机械通气组治疗后1h动脉血氧分压、二氧化碳分压相比差异无统计学意义（P均〉0．05）；INSURE组治疗后12h动脉血氧分压、二氧化碳分压分别为（89．4±11．5）mmHg、（44．2±5．9）mmHg，与机械通气组[分别为（90．2±10．8）mmHg、（39．1±7．3）mmHg]相比差异也无统计学意义（t分别为0．093、0．126，P均〉0．05）。（3）组间疾病发生情况比较：INSURE组患儿呼吸机相关性肺炎、气漏、颅内出血和慢性肺疾病的发生率分别为7．3％（3／41）、4．9％（2／41）、4．9％（2／41）和4．9％（2／41），均低于机械通气组[分别为34．1％（14／42）、16．7％（7／42）、19．0％（8／42）和11．9％（5／42）]，差异均有统计学意义（X^2分别为27．470、8．651、8．814和4．275，P均〈0．05）。1NSURE组患儿呼吸机使用时间、用氧时间、住NICU时问分别为5d（3～7d）、8d（5～11d）和16d（11～25d），短于机械通气组[分别为8d（4～12d）、12d（8～22d）和21d（12～35d）]，差异均有统计学意义（Z分别为-1．947、-2．013和-1．782，P均〈0．05）。结论极低及超低出生体重儿应用INSURE技术进行呼吸支持，创伤小、并发症少、用氧时间短、费用低、安全性高。
Objective To investigate the clinical value of INSURE technology in very low and extremely low birth weight infants requiring respiratory support. Methods From June 2010 to August 2012, 83 cases of very low and extremely low birth weight infants who had difficulty in breathing and required respiratory support were admitted into First Hospital of Tsinghua University and divided into two groups： INSURE group （n=41） and mechanical ventilation （MV） group （n=42）. Infants in INSURE group accepted intubate pulmonary surfactant extubate to continuous positive airway pressure and those in MV group accepted intubation with or without pulmonary surfactant treatment,and mechanical ventilation without extubation. Arterial blood gases at 1 h and 12 h after treatment were compared between the two groups by l test. The incidence of respiratory distress syndrome, ventilator associated pneumonia, air leaking, chronic lung disease, intracranial hemorrhage, retinopathy, leukoencephalomalacia disease were compared with Chi square test. Hospitalization costs, duration of ventilation, oxygen inhalation and hospital stay were compared by rank-sum test. Results （1） PO2 in INSURE group after one hour of treatment were （78.7 ± 11.5） mm Hg（1 mm Hg 0.133 kPa）, which were higher than those before treatment [（50.1±10.8） mm Hg,t 9.737, P〈0.05]; while PCO2 was lowerE（48.3±8.9） mm Hg vs （54.9± 11.5） mm Hg,t=-3.428, P〈0.05]. PO2 in MV group after one hour of treatment were （80.2± 10.0） mm Hg, which were higher than those before treatment [（51.3±9.8） mm Hg, t 10.093, P〈0. 05]; whilePCO2waslower[（45.6±9.5） mmHgvs（57.1±12.8） mmHg, t=4.526, P〈0.05]. （2） There were no difference in PO2 and PCO2 between the two groups after one hour of treatment （P〉0.05）. After 12 hours of treatment, no differences were found in PO2[（89.4±11.5） mm Hgvs （90.2±10.8） mm Hg, t=0.093] and PCO2[（44.2±5.9） mm Hg vs （39.1± 7.3） mm Hg, t=0.1261 between INSURE group and MV group （P〉0.05 respectively）. （3） The incidence of ventilator associated pneumonia, air leaking, intracranial hemorrhage and chronic lung disease in INSURE group were 7.3% （3/41）, 4.9% （2/41）, 4.9%（2/41） and 4.9% （2/41）, which were lower than those in MV group [34.1% （14/42）, 22 =27. 470; 16.7% （7/42）,X^2=8.651; 19.0%（8/42）, X^2 =8.814; 11.9%（5/42）,X^2=4.275]（P〈0.05 respectively）. Duration of ventilation, oxygen inhalation, neonatal intensive care unit stay in INSURE group were 5 d （3 7 d）, 8 d （5 11 d） and 16 d （11-25 d）, which were all shorter than those of MV group E8 d （4-12 d）, Z=-1.947; 12 d （8-22 d）, Z=-2.013; 21 d （12-35 d）, Z=-1.782]（P〈0. 05 respectively）. Conclusions INSURE tcchnology could be used in very low and extremely low birth weight infants because of less invasiveness, fewer complications, safety and low cost.
出处
《中华围产医学杂志》
CAS
北大核心
2013年第1期30-34,共5页
Chinese Journal of Perinatal Medicine
关键词
婴儿
极低出生体重
婴儿
超低出生体重
肺表面活性剂
连续气道正压通气
Infant, very low birth weight
Infant, extremely low birth weight
Pulmonarysurfactants
Continuous positive airway pressure
