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目的探讨INSURE技术联合T-piece治疗新生儿呼吸窘迫综合征(RDS)的疗效。方法将我院新生儿病房2010年2月至2011年2月住院的RDS早产儿随机分为观察组与对照组。观察组予以T-piece联合INSURE技术,对照组予以复苏囊联合INSURE技术,比较两组患儿气管插管注入肺表面活性物质过程中血氧饱和度(SPO2)最低值、心率(HR)最低值、吸氧浓度(FiO2)平均值、二次加压给氧比例、鼻塞持续气道正压通气(nCPAP)应用时间、用药前及用药1h后血气情况、近远期并发症发生率。结果观察组和对照组各入选47例RDS早产儿,观察组SPO2和HR的最低值均高于对照组[SPO2:(90.8±3.6)%比(81.5±2.9)%,HR:(117.5±9.6)次/min比(110.1±9.1)次/min,P<0.05],二次加压给氧比例和FiO2均低于对照组[加压给氧比例:6.4%比19.1%,FiO2:(0.31±0.07)比(0.36±0.08),P<0.05]。治疗前两组患儿FiO2差异无统计学意义(P>0.05);治疗后1h观察组FiO2小于对照组[(26.2±4.4)比(28.8±5.8),P<0.05]。观察组颅内出血的发生率低于对照组(23.4%比44.7%,P<0.05),两组气胸、肺出血、支气管肺发育不良及早产儿视网膜病变的发生率差异无统计学意义(P>0.05)。结论应用T-piece联合INSURE技术治疗可以更好的改善RDS患儿氧合,减少气压伤及高氧损伤的时间,减少颅内出血的发生,不增加肺出血的发生,值得在临床推荐。
Objective To investigate the efficacy of INSURE combined with T-piece in the treatment of neonatal respiratory distress syndrome (RDS). Methods Preterm infants with RDS who were hospitalized from February 2010 to February 2011 were randomly divided into observation group and control group. The observation group was treated with T-piece combined with INSURE technique. The control group was treated with resuscitation capsule combined with INSURE technique. The lowest SPO2 and the lowest HR in both groups were compared between the two groups , Average oxygen concentration (FiO2), the proportion of secondary pressure to oxygen, nasal continuous positive airway pressure (nCPAP) application time, medication and medication 1h after the blood gas situation, the incidence of short-term and long-term complications. Results The observation group and the control group were selected 47 cases of RDS preterm infants, the observation group SPO2 and HR minimum were higher than the control group [SPO2: (90.8 ± 3.6)% (81.5 ± 2.9)%, HR: (117.5 ± 9.6 ) Times / min (110.1 ± 9.1) times / min, P <0.05), the secondary oxygenation rate and FiO2 were lower than those in the control group [6.4% vs 19.1%, FiO2: ± 0.07) (0.36 ± 0.08), P <0.05]. There was no significant difference in FiO2 between two groups before treatment (P> 0.05). FiO2 in observation group 1 hour after treatment was lower than that in control group [(26.2 ± 4.4) vs (28.8 ± 5.8), P <0.05]. The incidence of intracranial hemorrhage in the observation group was lower than that in the control group (23.4% vs 44.7%, P <0.05). There was no significant difference in the incidence of pneumothorax, pulmonary hemorrhage, bronchopulmonary dysplasia and retinopathy of prematurity between the two groups (P> 0.05 ). Conclusion T-piece combined with INSURE can improve the oxygenation, reduce the time of barotrauma and hyperoxic injury, reduce the incidence of intracranial hemorrhage, and not increase the incidence of pulmonary hemorrhage. It is worth to be recommended clinically.