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目的探讨肺复张策略在早产儿呼吸窘迫综合征(RDS)中的治疗效果。方法选择我院新生儿重症监护中心住院的符合纳入标准的RDS早产儿,随机分为肺复张组与对照组,其中肺复张组在机械通气同时行肺复张。记录两组新生儿治疗后1、6 h的吸入氧浓度(FiO_2)、呼气末正压(PEEP)、平均气道压(MAP),并计算氧合指数(OI),两组进行比较分析,并对肺复张组复张前后不同时间点FiO_2、PEEP、OI的变化进行比较。结果共纳入RDS早产儿25例,其中肺复张组12例,对照组13例,两组新生儿性别、胎龄、出生体重,以及开始肺复张前FiO_2、PEEP和OI比较差异均无统计学意义(P>0.05)。肺复张组1、6 h的FiO_2均低于对照组[(31±8)%比(49±14)%、(25±5)%比(43±13)%],1、6 h的OI亦低于对照组[(4.3±1.5)比(6.9±4.0)、(3.2±1.4)比(6.0±3.6)],差异均有统计学意义(P<0.05)。肺复张组1、6 h的FiO_2及OI均低于肺复张前(P<0.05),PEEP高于肺复张前(P<0.05),6 h的FiO_2及OI均低于1 h(P<0.05)。与对照组比较,肺复张组并未增加肺表面活性物质使用次数及拔管失败、支气管肺发育不良、医院感染的比例(P>0.05),但可减少总呼吸支持时间及氧疗时间(P<0.05)。结论肺复张策略治疗早产儿RDS能较快改善OI,减少呼吸支持时间及氧疗时间。
Objective To investigate the therapeutic effect of pulmonary tonic recovery in respiratory distress syndrome (RDS) in preterm infants. Methods Preterm infants with RDS who met the inclusion criteria were enrolled in our hospital neonatal intensive care center. Patients were randomly divided into lung recurrent group and control group. The lung recurrent group also received pulmonary reexpansion simultaneously with mechanical ventilation. FiO2, PEEP and MAP were recorded at 1,6 h after neonatal treatment, and the oxygenation index (OI) was calculated. The two groups were compared and analyzed , And the changes of FiO_2, PEEP and OI at different time points before and after reexpansion were compared. Results A total of 25 preterm infants with RDS were included in this study. Among them, 12 cases were pulmonary reexpansion and 13 cases were control. There was no significant difference in FiO_2, PEEP and OI between the two groups in terms of sex, gestational age, birth weight, Significance (P> 0.05). FiO_2 at 1 and 6 h after lung recruitment was significantly lower than that of control group [(31 ± 8)% vs (49 ± 14)%, (25 ± 5)% vs (43 ± 13)%] OI was also lower than that of the control group [(4.3 ± 1.5) vs. (6.9 ± 4.0) vs (3.2 ± 1.4) vs. (6.0 ± 3.6)], respectively. The differences were statistically significant (P <0.05). FiO_2 and OI at 1 and 6 h after lung recruitment were lower than those before lung recruitment (P <0.05), and PEEP was higher than before lung recruitment (P <0.05). FiO_2 and OI at 6 h were lower than 1 h P <0.05). Compared with the control group, pulmonary reexpansion group did not increase the use of pulmonary surfactant and extubation failure, bronchopulmonary dysplasia, the proportion of nosocomial infections (P> 0.05), but can reduce the total respiratory support time and oxygen therapy time P <0.05). Conclusion The strategy of pulmonary reponse for RDS in preterm infants can improve OI quickly and reduce respiratory support time and oxygen therapy time.