A Clinical Practice Analysis Of Early Respiratory Management In Preterm Infants With Gestational Ages＜32 Weeks

Objective The purpose of this paper is to summarize to the respiratory management practices by analyse retrospectively therapeutic method and clinical efficiencies of preterm infants with gestational ages<32 weeks with hyaline membrane disease (HMD) in our hospital.Method Preterm infants with gestational ages (GA)<32 weeks (n=116) were analyzed retrospectively, of which 105 with HMD, and 11 with not.Among the 105 cases, mild-moderate HMD group had 85 cases and severe HMD group had 20 cases.Including the primary treatment of the respiratory management within postnatal 3 days, neonate with mild to moderate HMD was divided into 4 groups,sixteen treated with simple mechanical ventilation were in group 1, 21 with pure PS were in group 2,26 with mechanical ventilation combined PS were in group 3, and 22 not treated specially were in group 4. The time of ventilation,oxotherapy,significant improvement in respiratory distress syndrome and hospitalization, as well as complication incidence,mortality within postnatal 7 days and improvement of arterial blood gas analysis were all statistically analyzed in these 4 groups; compared to the efficacy of PS between group 2 and 3 and to the treatment effect of mechanical ventilation between group 1 and 3. This data of neonate with no of severe HMD and HMD was analyzed.Results(1) In the time of ventilation,oxotherapy,significant improvement in respiratory distress syndrome and hospitalization,as well as mortality within postnatal 7 days and improvement of arterial blood gas analysis,there were all significant differences among the 4 groups(P<0.05).(2) The time of starting using PS in group 2 and group 3 were all within 6-12h after birth, no significant difference between the two groups (5.28±7.90 h VS 3.87±3.77 h, P>0.05), the dose of PS between the two groups was no significant (88.68±18.84mg/kg VS 96.38±30.11mg/kg, P>0.05).(3) The time of starting using mechanical ventilation were significant differences between group 1 and group 3 (29.72±9.43 h VS 5.49±6.73 h, P<0.05), the total time of using mechanical ventilation was also statistically significant (41.31±27.5 1h VS 26.31±16.90h, P <0.05). Conclusion(1) Mechanical ventilation combined with exogenous surfactant therapy in the preterm infants with gestational age<32 weeks with HMD could rapidly improve pulmonary ventilation and oxygenation, alleviated respiratory distress symptoms, shorten the duration of mechanical ventilation and total oxygen time, reduced hospital day and the mortality, significantly improved the outcome in preterm babies, advanced the survival rate of premature babies.(2)The premature infants with gestational age<32 weeks with HMD should be apply PS early(within 6-12 hours after birth), generally mild-to-moderate HMD were given 120mg PS, severe HMD can be appropriately increase dosage(150-240mg/kg), early (best within 6 hours after birth) and united SIMV ventilation with lower PIP and PEEP and inhaled oxygen concentration.The total time of using mechanical ventilation try to<24h in mild-moderate HMD children, and< 72 hours in severe one can reduce the incidence of ventilator-associated pneumonia, broncho-pulmonary dysplasia (BPD), gas leakage, intracranial hemorrhage and lung hemorrhage.