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目的:探讨RDS患儿使用CPAP治疗时,在自主呼吸同时通过5F导管给予气管内注入PS的可行性,并探讨与INSURE技术相比较,治疗RDS的疗效。方法:将长春市妇产医院2012年6月~2013年12月分娩室内出生胎龄27~32周的RDS早产儿随机分为观察组和对照组。观察组使用CPAP自主呼吸同时,在喉镜下通过5F导管给予PS治疗;对照组采用INSURE技术,即喉镜下,通过气管插管给予PS注入,并正压通气。比较两组患儿注入PS后,SPO2、心率下降程度、吸氧浓度Fi O2、用药前后1 h血气变化及并发症情况。结果:观察组和对照组各入选46例RDS早产儿,在使用PS过程中,观察组SPO2和心率下降的最低值均高于对照组(P<0.05),而吸氧浓度Fi O2低于对照组(P<0.05),用药前Fi O2、血气中PO2无统计学差异(P>0.05),而用药后1 h的Fi O2较对照组低(P<0.05),血气中PO2较对照组高(P<0.05)。观察组和对照组两组患儿气胸、肺出血、BPD等并发症无统计学差异(P>0.05)。结论:应用5F导管注入PS能够更好改善氧合,减少气压伤及高氧损伤,并不增加并发症。
OBJECTIVE: To investigate the feasibility of intratracheal instillation of PS with spontaneous breathing through 5F catheters in children with RDS when treated with CPAP and to explore the efficacy of RDS in comparison with INSURE technique. Methods: The preterm infants born at Changchun Maternity Hospital from June 2012 to December 2013 with a gestational age of 27 ~ 32 gestational weeks were randomly divided into observation group and control group. The observation group was treated with CPAP spontaneous breathing at the same time, under the laryngoscope through the 5F catheter to give PS treatment; control group using INSURE technology, namely under the laryngoscope, PS injection through the endotracheal tube, and positive pressure ventilation. The PSO2, SPO2, the decrease of heart rate, FiO2, blood gas changes 1 h before and after treatment were compared between the two groups. Results: In the observation group and the control group, 46 RDS preterm infants were enrolled. During the course of using PS, the lowest values of SPO2 and heart rate in observation group were higher than those in control group (P <0.05) (P <0.05). There was no significant difference in FiO2 before treatment and PO2 in blood gas (P> 0.05), but FiO2 at 1 h after treatment was lower than that in control group (P <0.05), PO2 in blood gas was higher than that in control group (P <0.05). There was no significant difference in the complication of pneumothorax, pulmonary hemorrhage and BPD between observation group and control group (P> 0.05). Conclusion: The application of 5F catheter into PS can better improve oxygenation, reduce barotrauma and hyperoxia injury, and does not increase the complications.