2019 年第 11 期 第 14 卷

持续气道正压通气联合牛肺泡表面活性剂对新生儿呼吸窘迫综合征患儿脑氧代谢的作用分析

Effect of continuous positive airway pressure ventilation combined with bovine alveolar surfactant on cerebral oxygen metabolism in neonates with respiratory distress syndrome

作者：王捷荣李慧娟黄倩熊英

英文作者：

单位：430070武汉大学中南医院儿科

英文单位：

关键词：新生儿呼吸窘迫综合征；持续气道正压通气；肺泡表面活性剂；脑氧代谢

英文关键词：

• 摘要：

• 【摘要】目的    分析持续气道正压通气（CPAP）联合牛肺泡表面活性剂对新生儿呼吸窘迫综合征（NRDS）患儿脑氧代谢的作用。方法    选取2016年1月至2018年12月武汉大学中南医院收治的NRDS患儿140例为研究对象。采用随机数字表法分为对照组和观察组，各70例。对照组在常规治疗的基础上给予CPAP治疗；观察组在常规治疗的基础上给予CPAP联合牛肺泡表面活性剂治疗。分析2组患儿的临床治疗效果、治疗前后全身氧代谢指标及脑氧饱和度的变化。结果    观察组治疗总有效率高于对照组［94.3%（66/70）比82.9%（58/70）］，差异有统计学意义（χ2=2.547，P=0.012）。观察组CPAP持续时间、吸氧时间、住院时间均短于对照组，差异均有统计学意义（均P<0.05）。治疗后2组动脉血氧分压、氧合指数均较治疗前升高，且观察组高于对照组［（11.6±2.1）kPa比（10.3±1.4）kPa、（23.6±4.3）kPa比（18.7±3.2）kPa］；动脉血二氧化碳分压、吸入氧浓度均较治疗前降低，且观察组低于对照组［（4.9±1.1）kPa比（5.5±0.9）kPa、（32±6）%比（44±5）%］，差异均有统计学意义（均P<0.01）。2组患者治疗时脑氧饱和度均较治疗前明显升高，差异均有统计学意义（均P<0.05），而治疗后10、30 min逐步降低，相同时间点组间差异均无统计学意义（均P>0.05）。结论    CPAP联合牛肺泡表面活性剂对NRDS患儿的异常脑氧代谢改善作用比单独CPAP治疗效果更显著。

• 【Abstract】Objective    To investigate the effect of continuous positive airway pressure(CPAP) ventilation combined with bovine alveolar surfactant on cerebral oxygen metabolism in infants with neonatal with respiratory distress syndrome(NRDS). Methods    A total of 140 cases of NRDS admitted to Zhongnan Hospital of Wuhan University from January 2016 to December 2018 were randomly divided into control group and observation group, with 70 cases in each group. The control group was treated with CPAP ventilation on the basis of routine treatment. The observation group was treated with CPAP ventilation and bovine alveolar surfactant on the basis of routine treatment. Clinical efficacy, systemic oxygen metabolism indexes and cerebral oxygen saturation were analyzed. Results    Total effective rate in observation group was significantly higher than that in control group［94.3%(66/70) vs 82.9%(58/70)］(χ2=2.547, P=0.012). CPAP ventilation time, oxygen uptaking time and hospitalization time in observation group were significantly shorter than those in control group(all P<0.05). After treatment, arterial partial pressure of oxygen and oxygenation index were improved in both groups, and the indexes in observation group was significantly higher than those in control group［（11.6±2.1）kPa vs （10.3±1.4）kPa, （23.6±4.3）kPa vs （18.7±3.2）kPa］; arterial partial pressure of carbon dioxide and inhaled oxygen concentration reduced in both groups and they were lower in observation group than those in control group［（4.9±1.1）kPa vs （5.5±0.9）kPa, （32±6）% vs （44±5）%］(all P<0.01). Cerebral oxygen saturation significantly rose during treatment in both groups(P<0.05), but gradually decreased at 10 and 30 min after treatment; no significant difference was noticed between groups(P>0.05). Conclusion    CPAP ventilation combined with bovine alveolar surfactant treating NRDS can obviously improve cerebral oxygen metabolism.