气泡式鼻塞持续气道正压通气联合氨溴索早期防治早产儿呼吸窘迫综合征疗效研究

doi:10.3877/cma.j.issn.1673-5250.2012.02.015

目的

探讨早期应用气流驱动式(IFD)气泡式鼻塞持续气道正压通气(BNCPAP)联合大剂量氨溴索防治早产儿呼吸窘迫综合征(NRDS)的疗效。

方法

选取2009年10月至2011年9月于本院产科分娩后30 min内转入本科的79例早产儿为研究对象，并按照转入顺序随机分为治疗组(IFD－BNCPAP＋大剂量氨溴索，n＝42)及对照组(常规治疗，n＝37)。观察两组患儿生命体征、NRDS发生率、机械通气(MV)使用率、通气时间、住院时间、MV治疗前及12 h后血气分析、呼吸指数(RI)及氧合指数(OI)、肺动态顺应性(Crs)、呼吸道阻力(R)、压力容量(P－V)曲线斜率及并发症发生率，并对结果进行统计学分析(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与之签署临床研究知情同意书)。

结果

两组患儿NRDS发生率和MV使用率比较，差异有统计学意义(P<0.05)。治疗组通气时间及住院时间较对照组明显减少，差异有统计学意义(P<0.05)。两组MV治疗前及12 h后二氧化碳分压(PaCO₂)、OI及RI比较，差异有统计学意义(P<0.01)，pH值比较，差异无统计学意义(P>0.05)；两组上机24 h及72 h后，Crs，R及P－V曲线斜率比较，差异有统计学意义(P<0.01)。治疗组并发症发生率低于对照组，但差异无统计学意义(P>0.05)。

结论

早期应用IFD－BNCPAP联合大剂量氨溴索可提高肺顺应性，改善肺氧合功能，对NRDS具有良好疗效。

关键词: 早产儿, 呼吸窘迫综合征, 持续气道正压通气, 氨溴索, 预防, 治疗

Objective

To evaluate the effect of infant flow driver bubble nasal continuous positive airway pressure (IFD-BNCPAP) combined with large dose ambroxol in the prevention and treatment on neonatal respiratory distress syndrome(NRDS).

Methods

From October 2009 to September 2011, 79 premature infants who were born within 30 min and sent in department of neonatology were included in the study, and were divided randomly into treatment group(IFD-BNCPAP+ ambroxol, n=42) and control group (regular treatment, n=37). The vital sign, incidence rate of NRDS, usage rate of mechanical ventilation (MV), duration of ventilation and hospitalization, blood gas analysis results, respiratory index (RI), respiratory compliance(Crs), resistance(R) and pressure-volume curve (P-V) slope of curve were observed and statistically analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Hospital of Weifang Medical University.Informed consent was obtained from each parents.

Results

There were significant differences in incidence rate of NRDS and usage rate of MV between two groups(P<0.05). The duration of ventilation and hospitalization in treatment group was obviously lower than those in control group(P<0.05). The blood gas analysis results showed that there had significant difference in PaCO₂, RI, Crs, R and P-V slope of curve between two groups(P<0.05). There was no significant difference in incidence rate of complication between two groups(P>0.05).

Conclusions

The IFD-BNCPAP combined with large dose ambroxol on premature infants with NRDS had great effect in early time.This method can effectively improve oxygenation function, meanwhile can prevent and treat NRDS.

Key words: premature infant, respiratory distress syndrome, continuous positive airway pressure, ambroxol, prevention, treatmennt

表1 两组患儿预防效果比较(±s)

Table 1 Comparison of preventive effects between two groups(±s)

组别	n	NRDS发生率[n(%)]	MV使用率[n(%)]	通气时间(h)	住院时间(d)
治疗组	42	6(14.29)	5(11.91)	60.60± 7.89	20.24±2.43
对照组	37	12(32.43)	10(27.03)	96.80±10.14	24.14±2.14
χ²或t	?	3.69	4.34	－6.95	－7.53
P	?	<0.05	<0.05	<0.05	<0.05

表1 两组患儿预防效果比较(±s)

Table 1 Comparison of preventive effects between two groups(±s)

组别	n	NRDS发生率[n(%)]	MV使用率[n(%)]	通气时间(h)	住院时间(d)
治疗组	42	6(14.29)	5(11.91)	60.60± 7.89	20.24±2.43
对照组	37	12(32.43)	10(27.03)	96.80±10.14	24.14±2.14
χ²或t	?	3.69	4.34	－6.95	－7.53
P	?	<0.05	<0.05	<0.05	<0.05

表2 两组机械通气治疗前及12 h后血气分析结果比较(±s)

Table 2 Comparison of blood gas analysis results before and after 12 h of mechanical ventilation treatment between two groups (±s)

组别	PaO₂(mm Hg)		PaCO₂ (mm Hg)		pH值		OI		RI
组别	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后
治疗组	60.00±1.01	72.80±1.93	51.00±2.74	45.60±1.14	7.34±0.02	7.38±0.03	113.75±8.24	145.60±3.85	5.23±0.51	4.12±0.13
对照组	53.60±1.27	66.90±1.53	56.90±2.13	51.50±1.58	7.33±0.02	7.37±0.02	93.76±7.36	118.10±10.40	6.28±0.58	5.11±0.50
t	9.82	6.50	－4.61	－7.38	0.11	1.04	4.77	5.63	－3.4	－4.27
P	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05	<0.01	<0.01	<0.01	<0.01

表2 两组机械通气治疗前及12 h后血气分析结果比较(±s)

Table 2 Comparison of blood gas analysis results before and after 12 h of mechanical ventilation treatment between two groups (±s)

组别	PaO₂(mm Hg)		PaCO₂ (mm Hg)		pH值		OI		RI
组别	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后	治疗前	12 h后
治疗组	60.00±1.01	72.80±1.93	51.00±2.74	45.60±1.14	7.34±0.02	7.38±0.03	113.75±8.24	145.60±3.85	5.23±0.51	4.12±0.13
对照组	53.60±1.27	66.90±1.53	56.90±2.13	51.50±1.58	7.33±0.02	7.37±0.02	93.76±7.36	118.10±10.40	6.28±0.58	5.11±0.50
t	9.82	6.50	－4.61	－7.38	0.11	1.04	4.77	5.63	－3.4	－4.27
P	<0.01	<0.01	<0.01	<0.01	>0.05	>0.05	<0.01	<0.01	<0.01	<0.01

表3 两组患儿相关呼吸力学参数比较(±s)

Table 3 Comparison of respiratory mechanical parameters between two groups(±s)

组别	Crs[mL/(cm H₂O·kg)]		R[cm H₂O/(L·S)]		P－V slope of curve
组别	24 h	72 h	24 h	72 h	24 h	72 h
治疗组	0.44±0.01	0.52±0.02	81.40±1.82	70.60±2.07	1.33±0.03	1.51±0.01
对照组	0.38±0.01	0.47±0.02	88.20±2.15	80.00±2.26	1.28±0.02	1.48±0.02
t	8.74	5.02	－6.05	－7.78	4.22	3.52
P	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

表3 两组患儿相关呼吸力学参数比较(±s)

Table 3 Comparison of respiratory mechanical parameters between two groups(±s)

组别	Crs[mL/(cm H₂O·kg)]		R[cm H₂O/(L·S)]		P－V slope of curve
组别	24 h	72 h	24 h	72 h	24 h	72 h
治疗组	0.44±0.01	0.52±0.02	81.40±1.82	70.60±2.07	1.33±0.03	1.51±0.01
对照组	0.38±0.01	0.47±0.02	88.20±2.15	80.00±2.26	1.28±0.02	1.48±0.02
t	8.74	5.02	－6.05	－7.78	4.22	3.52
P	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

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Therapeutic Effect of Bubble Nasal Continuous Positive Airway Pressure Combined With Ambroxol on Neonatal Respiratory Distress Syndrome

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Therapeutic Effect of Bubble Nasal Continuous Positive Airway Pressure Combined With Ambroxol on Neonatal Respiratory Distress Syndrome