探讨早期呼吸支持优化策略，即早期应用呼吸窘迫综合征(RDS)高危早产儿持续气道正压通气(CPAP)＋选择性使用肺表面活性物质(PS)策略，在RDS管理中的临床意义。

选取2011年6月至2016年5月于新疆维吾尔自治区克拉玛依市中心医院收治的胎龄≤32孕周，或出生体重<1 200 g，有自主呼吸的95例RDS高危早产儿为研究对象。根据临床采取的早期呼吸支持治疗策略不同，将其分为研究组(n＝57，采用前瞻性研究方法，选择2013年12月至2016年5月，在本院接受早期呼吸支持优化策略进行早期干预的RDS高危早产儿)；对照组(n＝38，采用回顾性研究方法，选择2011年6月至2013年11月，在本院接受早期呼吸支持策略，即预防性使用PS进行早期干预的RDS高危早产儿)。统计学分析2组RDS高危早产儿预防性PS使用率、总PS使用率、生后5 d内气管插管率或机械通气(MV)率、RDS发生率、RDS导致的死亡率、支气管肺发育不良(BPD)发生率。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，2组采用的治疗方案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。

①2组RDS高危早产儿胎龄、出生体重、性别构成比、呼吸窘迫严重程度，以及胃液泡沫试验阴性率、剖宫产率、多胎率等RDS高危因素比较，差异均无统计学意义(P>0.05)。②研究组RDS高危早产儿预防性PS使用率、总PS使用率、生后5 d内气管插管率，均分别显著低于对照组，并且差异均有统计学意义(χ²＝27.880、11.515、13.068，P<0.001)；而RDS发生率、生后5 d内MV率、RDS导致的死亡率及BPD发生率2组间分别比较，差异均无统计学意义(P>0.05)。

对RDS高危早产儿于早期进行CPAP＋选择性使用PS为主的早期呼吸支持优化策略，可显著减少预防性PS使用率、总PS使用率及生后5 d内气管插管率，并且不增加RDS高危早产儿的不良预后(RDS导致的死亡率与BPD发生率)。因本研究纳入样本量较小，这一与本地实际情况相结合的早期呼吸支持优化策略是否值得基层医院借鉴，则尚需多中心、大样本随机对照试验(RCT)进一步研究证实。

To study the clinical application of optimization strategy of early respiratory support in the management of respiratory distress syndrome(RDS)-high-risk premature infants, such as early continuous positive airway pressure (CPAP) + selective pulmonary surfactant (PS), and its clinical significances.

From June 2011 to May 2016, a total of 95 cases of RDS-high-risk premature infants with spontaneously breathing were enrolled in Central Hospital of Karamay City, whose gestational age were ≤ 32 weeks or birth weight were < 1 200 g . According to different early respiratory support treatment strategies, they were divided into two groups. From December 2013 to May 2016, a total of 57 cases of RDS-high-risk premature infants were enrolled as the study group and they were studied by prospective analytical studies method, during this period the optimized early respiratory support treatment strategy (early CPAP + selectivity PS-based strategy) was applied for early intervention. From June 2011 to November 2013, the clinical data of 38 cases of RDS-high-risk premature infants were selected as the control group and they were studied by retrospective analytical method, during that period the early prophylactic PS was recommended as early respiratory support strategy. Rate of prophylactic PS usage, rate of total PS usage, intubation rate in the first five days after birth, mechanical ventilation (MV) rate in the first five days after birth, incidence of RDS, mortality of RDS , incidence of bronchopulmonary dysplasia (BPD) between two groups were analyzed by statistical method. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Central Hospital of Karamay City. Informed consent was obtained from the parents of each participating neonate.

①There were no statistical differences beween two groups in the gestational age, birth weigth, ratio of gender, the severity of respiratory embarrassment, negative rate of gastric foam test, rate of uterine-incision delivery and high-order birth rate (P>0.05). ②In study group, rate of prophylactic PS usage, rate of total PS usage, intubation rate in the first five days after birth were much lower than those in control group, and the differences were statistically significant (χ²=27.880, 11.515, 13.068; P<0.001), but there were no significant differences between two groups in mechanical ventilation rate in the first five days after birth, incidence of RDS, the mortality of RDS-high-risk premature infants and incidence of BPD (P>0.05).

RDS-high-risk premature infants treated by optimized strategies based on early CPAP + selective PS can significantly reduce the rate of prophylactic PS usage, rate of total PS usage, and intubation rate in the first five days after birth, while it does not increase the incidence of adverse events, such as the mortality of RDS-high-risk premature infants and the incidence of BPD. Curative effect of optimization strategy of early CPAP + selective PS is good for the treatment RDS-high-risk premature infants in this study. As the sample size in this study is small, whether it is worthy of wide clinical application in primary hospitals, multi-center and large-sample randomized controlled trial (RCT) will be needed to confirm.