Effects of Different Mechanical Ventilation Modes Combined with Pulmonary Surfactant on the Treatment of Preterm Infants with Neonatal Respiratory Distress Syndrome

doi:10.3877/cma.j.issn.1673-5250.2014.04.012

Objective

To study the clinical effects of nasal continuous positive airway pressure (NCPAP), controlled mandatory ventilation (CMV) or synchronized intermittent mandatory ventilation (SIMV) combined with pulmonary surfactant (PS) on the treatment of neonatal respiratory distress syndrome (NRDS).

Methods

From January 2010 to March 2013, a total of 118 cases preterm infants with NRDS who hospitalized in Suining Central Hospital were selected into this study. They were divided into study group (n = 61, accepted NCPAP combined with PS treatment) and control group (n = 57, accepted CMV or SIMV combined with PS treatment). The study protocol was approved by the Ethical Review Board of Investigation in Suining Central Hospital. Informed consent was obtained from the guardians of each participate. Within 2 h after hospitalization, NCPAP combined with PS (study group), CMV or SIMV combined with PS (control group) were given to preterm infants with NRDS in two groups, respectively. Then results of blood gas analysis,duration of mechanical ventilation,duration of oxygen inhaled, hospitalization stay, incidence rate of complications and mortality were analyzed by statistic methods.

Results

① There were no statistically significant differences between two groups in gender, gestational age, age, birth weight and NRDS classification (P>0.05). ② There were no statistically significant differences between two groups in results of blood gas analysis at different time points and mortality (P>0.05).③ Duration of mechanical ventilation, duration of oxygen inhaled, hospitalization stay, incidence rate of complications in study group were significantly lower than those in control group, and the differences were significance (P<0.05).

Conclusions

Compared with CMV or SIMV combined with PS, NCPAP combined with PS could diminish duration of mechanical ventilation, duration of oxygen inhaled, hospitalization stay, and reduce incidence rate of complications without increasing their mortality. Whether NCPAP is a better lung protective ventilation mode for preterm infants with NRDS or not, there still needs large-scale randomized controlled multi-center clinical trials to prove.

Key words: Pulmonary surfactants, Respiratory distress syndrome, newborn, Ventilators, mechanical, Nasal continuous positive airway pressure, Infant, premature

表1 研究组与对照组一般临床资料比较[n(%)]

Table 1 Comparison of general clinical data between two groups[n(%)]

组别	n	性别		胎龄（孕周）			日龄		出生体质量（g〉		NRDS分级
组别	n	男	女	28～30	>30～32	>32～36	15～120 min	>2～24 h	<1 500	≥1 500	Ⅱ级	Ⅲ级
研究组	61	41(67.21)	20(32.79)	6(9.84)	24(39.34)	31(50.82)	48(78.69)	13(21.31)	28(45.90)	33(54.10)	36(59.02)	25(40.98)
对照组	57	38(66.67)	19(33.33)	4(7.02)	22(38.60)	31(54.38)	42(73.68)	15(26.32)	25(43.86)	32(56.14)	35(61.40)	22(38.60)
χ²		0.004		0.350			0.410		0.050		0.070
P		>0.05		>0.05			>0.05		>0.05		>0.05

表1 研究组与对照组一般临床资料比较[n(%)]

Table 1 Comparison of general clinical data between two groups[n(%)]

组别	n	性别		胎龄（孕周）			日龄		出生体质量（g〉		NRDS分级
组别	n	男	女	28～30	>30～32	>32～36	15～120 min	>2～24 h	<1 500	≥1 500	Ⅱ级	Ⅲ级
研究组	61	41(67.21)	20(32.79)	6(9.84)	24(39.34)	31(50.82)	48(78.69)	13(21.31)	28(45.90)	33(54.10)	36(59.02)	25(40.98)
对照组	57	38(66.67)	19(33.33)	4(7.02)	22(38.60)	31(54.38)	42(73.68)	15(26.32)	25(43.86)	32(56.14)	35(61.40)	22(38.60)
χ²		0.004		0.350			0.410		0.050		0.070
P		>0.05		>0.05			>0.05		>0.05		>0.05

表2 两组合并NRDS早产儿不同时段血气分析结果比较(±s)

Table 2 Comparison of results of blood gas analysis between two groups(±s)

组别	n	辅助通气治疗前			辅助通气治疗后6 h
组别	n	pH值	(mmHg)	(mmHg)	pH值	(mmHg)	(mmHg)
研究组	61	7.20±0.07	46.1±8.9	45.1±9.6	7.26±0.05	62.6±8.6	41.2±7.0
对照组	57	7.19±0.08	46.3±9.0	44.9±9.4	7.28±0.06	63.5±9.0	40.6±7.3
t		0.72	0.12	0.11	1.97	0.56	0.46
P		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	辅助通气治疗后12 h			辅助通气治疗后24 h
组别	pH值	(mmHg)	(mmHg)	pH值	(mmHg)	(mmHg)
研究组	7.30±0.05	80.6±7.4	39.2±4.9	7.32±0.05	82.6±6.3	38.3±5.4
对照组	7.31±0.06	82.4±8.6	40.8±6.9	7.33±0.06	84.3±7.6	40.2±6.1
t	0.99	1.22	1.46	0.99	1.33	1.79
P	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	辅助通气治疗后48～72 h
组别	pH值	(mmHg)	(mmHg)
研究组	7.36±0.06	86.4±4.2	36.4±6.4
对照组	7.35±0.04	85.3±5.7	36.1±6.6
t	1.06	1.20	0.21
P	>0.05	>0.05	>0.05

表2 两组合并NRDS早产儿不同时段血气分析结果比较(±s)

Table 2 Comparison of results of blood gas analysis between two groups(±s)

组别	n	辅助通气治疗前			辅助通气治疗后6 h
组别	n	pH值	(mmHg)	(mmHg)	pH值	(mmHg)	(mmHg)
研究组	61	7.20±0.07	46.1±8.9	45.1±9.6	7.26±0.05	62.6±8.6	41.2±7.0
对照组	57	7.19±0.08	46.3±9.0	44.9±9.4	7.28±0.06	63.5±9.0	40.6±7.3
t		0.72	0.12	0.11	1.97	0.56	0.46
P		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	辅助通气治疗后12 h			辅助通气治疗后24 h
组别	pH值	(mmHg)	(mmHg)	pH值	(mmHg)	(mmHg)
研究组	7.30±0.05	80.6±7.4	39.2±4.9	7.32±0.05	82.6±6.3	38.3±5.4
对照组	7.31±0.06	82.4±8.6	40.8±6.9	7.33±0.06	84.3±7.6	40.2±6.1
t	0.99	1.22	1.46	0.99	1.33	1.79
P	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05
组别	辅助通气治疗后48～72 h
组别	pH值	(mmHg)	(mmHg)
研究组	7.36±0.06	86.4±4.2	36.4±6.4
对照组	7.35±0.04	85.3±5.7	36.1±6.6
t	1.06	1.20	0.21
P	>0.05	>0.05	>0.05

表3 两组合并NRDS早产儿的呼吸机使用时间、用氧时间、住院天数、并发症发生率及病死率比较(±s)

Table 3 Comparison of duration use of respirator, continuous administration of oxygen inhaled, hospitalization time, incidence rate of complications and mortality between two groups (±s)

组别	n	呼吸机使用时间(h)	用氧时间(h)	住院天数(d)	[n(%)]并发症发生率	病死率[n(%)]
研究组	61	62.8±9.2	92.8±11.2	18.2±5.5	11(18.0)	7(11.48)
对照组	57	86.7±8.6	124.0±19.8	23.4±6.2	19(33.3)	6(10.53)
t/χ²		14.55	10.62	4.82	3.94	0.03
P		<0.05	<0.05	<0.05	<0.05	>0.05

表3 两组合并NRDS早产儿的呼吸机使用时间、用氧时间、住院天数、并发症发生率及病死率比较(±s)

Table 3 Comparison of duration use of respirator, continuous administration of oxygen inhaled, hospitalization time, incidence rate of complications and mortality between two groups (±s)

组别	n	呼吸机使用时间(h)	用氧时间(h)	住院天数(d)	[n(%)]并发症发生率	病死率[n(%)]
研究组	61	62.8±9.2	92.8±11.2	18.2±5.5	11(18.0)	7(11.48)
对照组	57	86.7±8.6	124.0±19.8	23.4±6.2	19(33.3)	6(10.53)
t/χ²		14.55	10.62	4.82	3.94	0.03
P		<0.05	<0.05	<0.05	<0.05	>0.05

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