廖克准 陆敦 覃慧

【摘要】 目的 探讨气管插管-肺表面活性物质-拔管后鼻塞式气道正压通气（INSURE）技术联合布地奈德雾化吸入治疗早产儿呼吸窘迫综合征（RDS）的临床效果。方法 将72例呼吸窘迫综合征早产儿按掷币法分为对照组和观察组各36例，對照组给予单独INSURE技术治疗，观察组采用INSURE技术联合布地奈德雾化吸入治疗，观察比较两组患儿治疗有效率和并发症发生率，再次使用PS、应用CPAP时间、再次气管插管率，治疗前和治疗1个疗程后血气指标。结果 观察组临床疗效优于对照组（P<0.05），并发症发生率、再次气管插管率低于对照组，再次使用PS、应用CPAP时间少于对照组（P<0.05或0.001），治疗1个疗程后动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、动脉氧分压/吸入氧浓度比值（PaO2/FiO2）、吸入氧浓度（FiO2）等血气指标改善优于对照组（P<0.001）。结论 相比于单独应用INSURE技术，INSURE技术联合布地奈德雾化吸入治疗早产儿RDS临床效果显著。

【关键词】 INSURE技术;布地奈德;NRDS

中图分类号：R725.6   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2020.07.009

【Abstract】 Objective To explore the clinical effect of Intubate-Surfactant-Extubate to CPAP（INSURE） technique combined with Budesonide aerosol inhalation in the treatment of premature infants with respiratory distress syndrome（RDS）.Methods 72 cases of children with RDS were divided into control group and observation group according to coin toss method，with 36 cases in each group.The control group were treated with INSURE technique alone，while the observation group were treated with INSURE technique combined with Budesonide aerosol inhalation.And then，the effective rate，complication rate，the time of using PS again，the time of CPAP application，re-intubation rate as well as blood gas indexes before and after 1 course of treatment of the two groups were observed and compared.Results The clinical efficacy of the observation group was better than that of the control group（P<0.05），the incidence of complications and re-intubation rate were lower than those of the control group，and the time of using PS and CPAP again was less than that of the control group（P<0.05 or 0.001）.After 1 course of treatment，the observation group had better improvement of blood gas indexes such as PaO2，PaCO2，PaO2/FiO2 and FiO2 than the control group（P<0.001）.Conclusion Compared with the single application of INSURE technique，INSURE technique combined with Budesonide aerosol inhalation has a significant clinical effect on the treatment of premature infants with RDS.

【Key words】 INSURE technique;Budesonide;NRDS

新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）是新生儿出生6 h后出现发绀、呼气性呻吟及呼吸困难等症状的呼吸系统疾病，因缺乏肺表面活性物质（pulmonary surfactant，PS）引起，多见于早产儿，胎龄越小发病率越高[1～2]。NRDS临床主要通过机械通气快速改善患儿通气、高浓度吸氧提高血氧浓度的方式进行治疗，以缓解患儿呼吸困难的临床症状，但易引发气漏综合征、支气管肺发育不良、颅内出血等并发症[3]。气管插管-肺表面活性物质-拔管后鼻塞式气道正压通气（Intubate-Surfactant-Extubate to CPAP，INSURE）是2007年欧洲NRDS防治指南提出的一种新型无创通气治疗方法，能改善新生儿呼吸状况，降低新生儿对机械通气的依赖，被认为是治疗呼吸窘迫综合征（RDS）最为有效和安全的方法之一[4]。INSURE技术治疗NRDS疗效显著，但仍有治疗失败而延误最佳机械通气时机，增加并发症发生的概率。布地奈德混悬液是一种具有抗炎、减轻肺水肿功能的雾化吸入激素[5]。……