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目的探讨应用气管插管-使用肺表面活性物质-拔管使用鼻塞式气道正压通气(NCPAP)即INSURE策略治疗新生儿肺透明膜病(HMD)的有效性及安全性。方法将2011年5月至2013年5月收治的HMD并同意使用PS的71例患儿随机分为INSURE策略治疗(观察组)36例和常频通气(CMV)治疗(对照组)35例。比较两组患儿肺功能、呼吸机上机时间、氧疗时间、并发症及转归。结果治疗48 h后观察组氧合指数较对照组明显增高,差异有统计学意义(P<0.01)。观察组与对照组PaCO2、上机时间差异均无统计学意义(P均>0.05),但观察组氧疗时间较对照组明显缩短(P<0.01),相关性肺炎发生率较对照组稍降低,但差异无统计学意义(P>0.05)。结论 INSURE策略能更好地改善HMD患儿氧合功能、缩短氧疗时间,具有很好的临床疗效及安全性。
Objective To investigate the effectiveness and safety of endotracheal intubation-extubation using nasal-plug positive airway pressure (NCPAP), an INSURE strategy, for the treatment of neonatal hyaline membrane disease (HMD) with endotracheal intubation. Methods Seventy-one children who underwent HMD from May 2011 to May 2013 who consented to using PS were randomly divided into 36 cases of INSURE strategy (observation group) and 35 cases of routine ventilatory (CMV) treatment (control group). The lung function, ventilator time, oxygen therapy time, complications and prognosis were compared between the two groups. Results After 48 hours of treatment, the oxygenation index of the observation group was significantly higher than that of the control group (P <0.01). PaCO2 in the observation group and the control group had no significant difference in the on-time (P> 0.05), but the oxygen therapy time in the observation group was significantly shorter than that in the control group (P <0.01), and the incidence of related pneumonia was slightly lower than that in the control group , But the difference was not statistically significant (P> 0.05). Conclusion The INSURE strategy can better improve the oxygenation function of HMD children and shorten the oxygen therapy time, and has good clinical efficacy and safety.