INSURE技术在极低和超低出生体重儿呼吸支持中的应用价值——83例临床分析
INSURE기술재겁저화초저출생체중인호흡지지중적응용개치——83례림상분석
Value of INSURE technology in respiratory support of very low and extremely low birth weight infants-analysis of 83 cases
  • 万方数据
    中华围产医学杂志 중화위산의학잡지
    CHINESE JOURNAL OF PERINATAL MEDICINE
    2013年 1期 30-34 ,共5页

    徐小静%虞人杰%王俊怡

    서소정%우인걸%왕준이

    婴儿,极低出生体重%婴儿,超低出生体重%肺表面活性剂%连续气道正压通气 嬰兒,極低齣生體重%嬰兒,超低齣生體重%肺錶麵活性劑%連續氣道正壓通氣
    영인,겁저출생체중%영인,초저출생체중%폐표면활성제%련속기도정압통기
    Infant,very low birth weight%Infant,extremely low birth weight%Pulmonary surfactants%Continuous positive airway pressure
    目的 探讨INSURE技术在极低及超低出生体重早产儿呼吸支持中的临床应用价值.方法 本研究为回顾性分析.清华大学第一附属医院2010年6月至2012年8月收治的有呼吸困难且需要呼吸支持的极低及超低出生体重儿83例,依据呼吸支持方法的不同分为INSURE组41例与机械通气组42例.INSURE组患儿生后尽快予以气管插管、气管内滴入肺表面活性物质、拔管后经鼻持续气道正压通气.机械通气组患儿生后予气管插管、气管内用或不用肺表面活性物质、不拔除气管导管直接连接呼吸机辅助通气.卡方检验、两独立样本t检验及秩和检验比较2组患儿治疗后1h、12h动脉血气改善情况,呼吸窘迫综合征、呼吸机相关性肺炎、气漏、慢性肺疾病、颅内出血、视网膜病变、脑白质软化等疾病的发生情况,以及呼吸机使用时间、用氧时间、住院时间、住院费用等.结果 (1)组内治疗前后氧合情况比较:INSURE组患儿治疗后1h动脉血氧分压为(78.7±11.5) mm Hg(1 mm Hg=0.133 kPa),高于治疗前[(50.1±10.8) mm Hg],而二氧化碳分压低于治疗前[(48.3±8.9) mm Hg与(54.9±11.5) mm Hg],差异均有统计学意义(t分别为9.737、-3.428,P均＜0.05).机械通气组患儿治疗后1h动脉血氧分压为(80.2±10.0) mm Hg,高于治疗前[(51.3±9.8) mm Hg],而二氧化碳分压低于治疗前[(45.6±9.5) mm Hg与(57.1±12.8) mmHg],差异均有统计学意义(t分别为10.093、-4.526,P均＜0.05).(2)组间氧合情况比较:INSURE组与机械通气组治疗后1h动脉血氧分压、二氧化碳分压相比差异无统计学意义(P均＞0.05)；INSURE组治疗后12 h动脉血氧分压、二氧化碳分压分别为(89.4±11.5) mm H g、(44.2±5.9) mm Hg,与机械通气组[分别为(90.2±10.8) mm Hg、(39.1±7.3) mm Hg]相比差异也无统计学意义(t分别为0.093、0.126,P均＞0.05).(3)组间疾病发生情况比较:INSURE组患儿呼吸机相关性肺炎、气漏、颅内出血和慢性肺疾病的发生率分别为7.3％(3/41)、4.9％(2/41)、4.9％(2/41)和4.9％(2/41),均低于机械通气组[分别为34.1％(14/42)、16.7％(7/42)、19.0％(8/42)和11.9％(5/42)],差异均有统计学意义(x2分别为27.470、8.651、8.814和4.275,P均＜0.05).INSURE组患儿呼吸机使用时间、用氧时间、住NICU时间分别为5 d(3～7 d)、8 d(5～11 d)和16d(11～25 d),短于机械通气组[分别为8 d(4～12 d)、12 d(8～22 d)和21 d(12～35 d)],差异均有统计学意义(Z分别为-1.947、-2.013和-1.782,P均＜0.05). 结论 极低及超低出生体重儿应用INSURE技术进行呼吸支持,创伤小、并发症少、用氧时间短、费用低、安全性高.
    목적 탐토INSURE기술재겁저급초저출생체중조산인호흡지지중적림상응용개치.방법 본연구위회고성분석.청화대학제일부속의원2010년6월지2012년8월수치적유호흡곤난차수요호흡지지적겁저급초저출생체중인83례,의거호흡지지방법적불동분위INSURE조41례여궤계통기조42례.INSURE조환인생후진쾌여이기관삽관、기관내적입폐표면활성물질、발관후경비지속기도정압통기.궤계통기조환인생후여기관삽관、기관내용혹불용폐표면활성물질、불발제기관도관직접련접호흡궤보조통기.잡방검험、량독립양본t검험급질화검험비교2조환인치료후1h、12h동맥혈기개선정황,호흡군박종합정、호흡궤상관성폐염、기루、만성폐질병、로내출혈、시망막병변、뇌백질연화등질병적발생정황,이급호흡궤사용시간、용양시간、주원시간、주원비용등.결과 (1)조내치료전후양합정황비교:INSURE조환인치료후1h동맥혈양분압위(78.7±11.5) mm Hg(1 mm Hg=0.133 kPa),고우치료전[(50.1±10.8) mm Hg],이이양화탄분압저우치료전[(48.3±8.9) mm Hg여(54.9±11.5) mm Hg],차이균유통계학의의(t분별위9.737、-3.428,P균＜0.05).궤계통기조환인치료후1h동맥혈양분압위(80.2±10.0) mm Hg,고우치료전[(51.3±9.8) mm Hg],이이양화탄분압저우치료전[(45.6±9.5) mm Hg여(57.1±12.8) mmHg],차이균유통계학의의(t분별위10.093、-4.526,P균＜0.05).(2)조간양합정황비교:INSURE조여궤계통기조치료후1h동맥혈양분압、이양화탄분압상비차이무통계학의의(P균＞0.05)；INSURE조치료후12 h동맥혈양분압、이양화탄분압분별위(89.4±11.5) mm H g、(44.2±5.9) mm Hg,여궤계통기조[분별위(90.2±10.8) mm Hg、(39.1±7.3) mm Hg]상비차이야무통계학의의(t분별위0.093、0.126,P균＞0.05).(3)조간질병발생정황비교:INSURE조환인호흡궤상관성폐염、기루、로내출혈화만성폐질병적발생솔분별위7.3％(3/41)、4.9％(2/41)、4.9％(2/41)화4.9％(2/41),균저우궤계통기조[분별위34.1％(14/42)、16.7％(7/42)、19.0％(8/42)화11.9％(5/42)],차이균유통계학의의(x2분별위27.470、8.651、8.814화4.275,P균＜0.05).INSURE조환인호흡궤사용시간、용양시간、주NICU시간분별위5 d(3～7 d)、8 d(5～11 d)화16d(11～25 d),단우궤계통기조[분별위8 d(4～12 d)、12 d(8～22 d)화21 d(12～35 d)],차이균유통계학의의(Z분별위-1.947、-2.013화-1.782,P균＜0.05). 결론 겁저급초저출생체중인응용INSURE기술진행호흡지지,창상소、병발증소、용양시간단、비용저、안전성고.
    Objective To investigate the clinical value of INSURE technology in very low and extremely low birth weight infants requiring respiratory support.Methods From June 2010 to August 2012,83 cases of very low and extremely low birth weight infants who had difficulty in breathing and required respiratory support were admitted into First Hospital of Tsinghua University and divided into two groups:INSURE group (n=41) and mechanical ventilation (MV) group (n=42).Infants in INSURE group accepted intubate-pulmonary surfactant-extubate to continuous positive airway pressure and those in MV group accepted intubation with or without pulmonary surfactant treatment,and mechanical ventilation without extubation.Arterial blood gases at 1 h and 12 h after treatment were compared between the two groups by t test.The incidence of respiratory distress syndrome,ventilator associated pneumonia,air leaking,chronic lung disease,intracranial hemorrhage,retinopathy,leukoencephalomalacia disease were compared with Chi-square test.Hospitalization costs,duration of ventilation,oxygen inhalation and hospital stay were compared by rank-sum test.Results (1) PO2 in INSURE group after one hour of treatment were (78.7 ±11.5) mm Hg(1 mm Hg=0.133 kPa),which were higher than those before treatment [(50.1 ±10.8) mm Hg,t=9.737,P＜0.05]; while PCO2 was lower[(48.3±8.9) mm Hg vs (54.9±11.5) mm Hg,t=-3.428,P＜0.05].PO2 in MV group after one hour of treatment were (80.2±10.0) mm Hg,which were higher than those before treatment [(51.3±9.8) mm Hg,t=10.093,P＜0.05]; while PCO2 was lower[(45.6±9.5) mm Hg vs (57.1±12.8) mm Hg,t=-4.526,P＜0.05].(2) There were no difference in PO2 and PCO2 between the two groups after one hour of treatment (P＞0.05).After 12 hours of treatment,no differences were found in PO2[(89.4±11.5) mm Hgvs (90.2±10.8) mm Hg,t=0.093] and PCO2[(44.2±5.9) mm Hg vs (39.1± 7.3) mm Hg,t=0.126] between INSURE group and MV group (P＞0.05 respectively).(3) The incidence of ventilator associated pneumonia,air leaking,intracranial hemorrhage and chronic lung disease in INSURE group were 7.3％ (3/41),4.9％ (2/41),4.9％ (2/41) and 4.9％ (2/41),which were lower than those in MV group [34.1％ (14/42),x2=27.470; 16.7％ (7/42),x2=8.651;19.0％ (8/42),x2 =8.814; 11.9％ (5/42),x2 =4.275](P＜0.05 respectively).Duration of ventilation,oxygen inhalation,neonatal intensive care unit stay in INSURE group were 5 d (3-7 d),8 d (5-11 d) and 16 d (11-25 d),which were all shorter than those of MV group [8 d (4-12 d),Z=-1.947; 12 d (8-22 d),Z=-2.013; 21 d (12-35 d),Z=-1.782](P＜0.05 respectively).Conclusions INSURE technology could be used in very low and extremely low birth weight infants because of less invasiveness,fewer complications,safety and low-cost.
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