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目的:探讨在早产极低出生体重儿中生后早期使用鼻塞式持续气道正压(nCPAP)或应用肺表面活性剂(PS)以预防新生儿呼吸窘迫综合征(NRDS)的临床疗效比较。方法:采用前瞻性对照研究,对出生后早期使用nCPAP辅助通气或早期使用PS替代治疗的早产极低出生体重儿进行对照研究,观察其死亡率、支气管肺发育不良发生率、辅助通气时间及临床并发症。结果:共106例患儿入选,死亡率和支气管肺发育不良(BPD)发生率组间比较差异无统计学意义。机械辅助通气、总用氧时间组间比较差异无统计学意义;nCPAP组PS使用数少于对照组(Odds Ratio:0.37,90%CI 0.209～0.655);气漏发生率低(Odds Ratio:0.476,90%CI 0.233～0.971),IVH发生率低(Odds Ratio:0.778,90%CI 0.319～1.898)。其他临床并发症组间比较差异无统计学意义。结论:早期应用nCPAP是预防早产极低出生体重儿呼吸窘迫综合征另一良好选择。
Objective: To investigate the clinical efficacy of nasal continuous positive airway pressure (nCPAP) or pulmonary surfactant (PS) in the prevention of neonatal respiratory distress syndrome (NRDS) in preterm neonates with very low birth weight. Methods: A prospective, controlled study was conducted to compare the effect of nCPAP-assisted ventilation in the early postnatal period or preterm low birth weight premature infants treated with PS replacement therapy. The mortality, the incidence of bronchopulmonary dysplasia, the time of assisted ventilation, complication. Results: A total of 106 children were enrolled, the mortality and the incidence of bronchopulmonary dysplasia (BPD) between the two groups showed no significant difference. There was no significant difference between the two groups in the time of mechanical ventilation and the time of total oxygen use. The use of PS in nCPAP group was less than that of the control group (Odds Ratio: 0.37, 90% CI 0.209-0.655) , 90% CI 0.233 ~ 0.971), the incidence of IVH was low (Odds Ratio: 0.778, 90% CI 0.319 ~ 1.898). Other clinical complications were no significant difference between groups. Conclusion: Early application of nCPAP is another good alternative to prevent respiratory distress syndrome in preterm very low birth weight infants.