张邦林 郑梅 陈秋萍 赵国林

【摘要】 目的：探讨高呼气末正压机械通气治疗新生儿呼吸窘迫综合征的效果及应用价值。方法：选取笔者所在医院2017年1月-2019年3月接收的80例新生儿呼吸窘迫综合征患儿，将其随机分为观察组（40例）与对照组（40例）。对照组给予常规治疗，观察组在对照组基础上增加高呼气末正压机械通气治疗。比较两组临床疗效、临床指标、预后情况。结果：观察组治疗总有效率高于对照组，差异有统计学意义（P<0.05）;观察组治疗后呼吸频率、HR、PaCO2水平较显著低于对照组及治疗前，且SpO2水平显著高于对照组及治疗前，差异均有统计学意义（P<0.05）。观察组治疗后新生儿危重病例评分、新生儿危重病例评分好转时间均优于对照组，全身感染发生率低于对照组，差异均有统计学意义（P<0.05）。结论：新生儿呼吸窘迫综合征患儿接受高呼气末正压机械通气治疗，可显著改善临床症状，具有较为理想的预后价值，值得推广。

【关键词】 高呼气末正压 机械通气 新生儿呼吸窘迫综合征 应用价值

doi：10.14033/j.cnki.cfmr.2019.29.016 文献标识码 B 文章编号 1674-6805（2019）29-00-03

[Abstract] Objective： To investigate the efficacy and application value of high positive end-expiratory pressure mechanical ventilation in the treatment of neonatal respiratory distress syndrome. Method： A total of 80 neonates with respiratory distress syndrome received in our hospital from January 2017 to March 2019 were randomly divided into the observation group （40 cases） and the control group （40 cases）. The control group was given routine treatment， while the observation group received high positive end-expiratory pressure mechanical ventilation on the basis of the control group. The clinical effects， clinical indicators and prognosis of the two groups were compared. Result： The total effective rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. After treatment， the respiratory rate， HR and PaCO2 levels of the observation group were significantly lower than those of the control group and before treatment， and the SpO2 level was significantly higher than that of the control group and before treatment， the differences were statistically significant （P<0.05）. After treatment， the scores of neonatal critical cases and the improvement time of neonatal critical cases in the observation group were better than those in the control group， and the incidence of systemic infection was lower than that in the control group， the differences were statistically significant （P<0.05）. Conclusion： Neonatal respiratory distress syndrome children receiving high positive end-expiratory pressure mechanical ventilation treatment can significantly improve clinical symptoms， has a better prognostic value， it is worth promoting.

[Key words] Positive end-expiratory pressure Mechanical ventilation Neonatal respiratory distress syndrome Application value

First-authors address： Huili County Peoples Hospital， Huili 615100， China

新生兒呼吸窘迫综合征，又称新生儿肺透明膜病，指新生儿出生后不久即出现进行性呼吸困难和呼吸衰竭等症状，主要是由于缺乏肺泡表面活性物质所引起，导致肺泡进行性萎陷，患儿于生后4～12 h内出现进行性呼吸困难、发绀、呻吟、吸气三凹征[1]。对于新生儿呼吸窘迫综合征患儿而言，常规治疗起效缓慢且效果并不尽人意，因此近年来常联合高呼气末正压机械通气进行治疗，取得了较为理想的效果[2]。基于此，本研究主要探讨高呼气末正压的机械通气治疗新生儿呼吸窘迫综合征的效果及应用价值，现报道如下。

1 资料与方法

1.1 一般资料

选取笔者所在医院2017年1月-2019年3月接收的新生儿呼吸窘迫综合征患儿80例，纳入标准：（1）新生儿危重病例评分均低于90分[3];（2）通过病史、临床症状、体征、胸部X片等明确诊断为新生儿呼吸窘迫综合征。排除标准：肠穿孔、肠梗阻等消化道疾病;代谢或内分泌疾病;家长配合依从性较差、病例脱落患儿。……