摘要
目的通过对比在持续气道正压通气(nasal continuous positive airway press,NCPAP)模式和双水平通气(bi-level positive airway pressure therapy,BiPAP)模式下使用微创肺泡表面活性物质给药(less-invasive surfactant administration,LISA)技术气管内注入肺泡表面活性物质(pulmonary surfactant,PS)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)患儿的变化,探讨改进LISA技术。方法选取2017年1月至2020年3月南京医科大学附属苏州科技城医院新生儿科和苏州市立医院本部新生儿科收治的60例RDS早产儿,均合并使用无创正压通气和PS替代治疗,PS均使用LISA技术注入气管。根据使用LISA时的不同无创模式,随机分为二组,NCPAP组(30例)采用NCPAP模式,BiPAP组(30例)采用BiPAP模式。对比二组患儿在注入PS后的经皮氧饱和度、心率、血压的变化以及药液反流情况。结果二组患儿在注入PS后均出现经皮氧饱和度的下降,NCPAP组较BiPAP组更低[(81.87±3.99)%比(87.53±2.64)%],差异有统计学意义(t=6.480,P<0.001);NCPAP组经皮氧饱和度下降持续时间更长[(10.5±3.27)s比(5.37±3.44)s,t=5.920,P<0.001],有部分患儿需要复苏囊正压辅助通气;NCPAP组心率出现降低,BiPAP组心率略有增快,二组比较差异有统计学意义(t=9.044,P<0.001);NCPAP组血压略有升高,BiPAP组血压改变不明显,二组比较差异无统计学意义(P>0.05);NCPAP组较BiPAP组注药后出现反流(24/30比7/30)和无创通气治疗失败情况(8/30比2/30)明显增多,差异有统计学意义(P<0.05)。在用药前后同组经皮氧饱和度和心率的变化差异均有统计学意义(P<0.05),血压变化不明显。使用专用的呼吸道导管(LISA管)较使用一次性胃管操作时间更短[(9.75±2.64)s比(16.87±6.12)s],插管后经皮氧饱和度更高,差异均有统计学意义(P<0.05)。结论在采用LISA技术给予PS联合无创通气治疗RDS时,最好使用BiPAP模式,有助于减少药物灌注时对患儿生理功能的干扰,促进疾病的恢复;使用LISA管在操作难易和对氧饱和度影响方面优于一次性胃管。
Objective:To compare the differences of patients with respiratory distress syndrome(RDS)treated by intratracheal injection of pulmonary surfactant using less-invasive surfactant administration(LISA)technology under nasal continuous positive airway press(NCPAP)and bi-level positive airway pressure therapy(BiPAP)mode,aiming to improve LISA technology.Methods:From January 2017 to March 2020,60 RDS preterm infants were selected from the Department of Neonatology at Suzhou Science and Technology City Hospital Affiliated to Nanjing Medical University and the Department of Neonatology of Suzhou Municipal Hospital.All of them were treated with noninvasive positive pressure ventilation and underwent pulmonary surfactant(PS)replacement therapy.The PS was injected into the trachea by LISA technology.Sixty children were randomly divided into two groups according to the different noninvasive modes of using LISA(NCPAP group and BiPAP group).The changes of transcutaneous oxygen saturation,heart rate,blood pressure and drug reflux after PS injection were compared between two groups.Results:After PS injection,the decrease of transcutaneous oxygen saturation was observed in both groups,especially in NCPAP Group[(81.87±3.99)%vs(87.53±2.64)%],and the difference was statistically significant(t=6.480,P<0.001).In NCPAP group,the duration of the decrease was longer[(10.5±3.27)s vs(5.37±3.44)s,t=5.920,P<0.001],and some children needed positive pressure ventilation of resuscitation sac.The heart rate of NCPAP group was lower than that in BiPAP group,and the difference was statistically significant(t=9.044,P<0.001).The blood pressure of NCPAP group was slightly higher than that in BiPAP group,but there was no significant difference between two groups(P>0.05).The incidence of reflux(24/30 vs 7/30)and treatment failure of noninvasive ventilation(8/30 vs 2/30)in NCPAP group were significantly higher than those in BiPAP group(P<0.05).Before and after treatment,there were significant differences in the changes of transcutaneous oxygen saturation and heart rate in the same group(P<0.05),but the change of blood pressure was not obvious(P>0.05).There were significant differences in operation time and transcutaneous oxygen saturation after intubation between disposable gastric tube and Lisa tube(P<0.05).Conclusion:When using LISA technology to treat RDS with PS combined with non-invasive ventilation,it is better to use BiPAP mode,which can help reduce the interference of physiological function of children during drug perfusion and promote the recovery of disease.The use of Lisa tube is easier to operate and has less impact on oxygen saturation in children than using disposable gastric tube.
作者
李永富
王旭莉
陈宇宏
宣勤
董淑玥
冯星
Li Yongfu;Wang Xuli;Chen Yuhong;Xuan Qin;Dong Shuyue;Feng Xing(Department of Neonatology,the Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University,Suzhou 215153,China;Department of Neonatology,Suzhou Municipal Hospital,Suzhou 215002,China;Department of Neonatology,Children's Hospital of Soochow University,Suzhou 215025,China)
出处
《中国小儿急救医学》
CAS
2020年第12期908-912,共5页
Chinese Pediatric Emergency Medicine
关键词
早产儿
呼吸窘迫综合征
持续气道正压
肺泡表面活性物质
Premature infant
Respiratory distress syndrome
Continuous positive airway pressure
Pulmonary surfactant
