Clinical Curative Effect Of Syndrome Of Pulmonary Surfactant Combined With Mechanical Ventilation In The Treatment Of Neonatal Respiratory Distress

Background and objectives:Neonatal respiratory distress syndrome, and is in newborns, especially one of the main diseases of premature infants early death, children in early stage after birth more progressive dyspnea, clinical manifestations of shortness of breath and inhale, exhale moan three concave), blue wait for a symptom, serious when can appear respiratory failure, hypotension or shock, so early detection and diagnosis of neonatal respiratory distress syndrome, and timely application of exogenous alveolar surface active substance and mechanical ventilation treatment, can quickly and effectively improve the patient’s clinical symptoms, improve the patient’s rescue success probability, reduce the mortality rate of children. CPAP belongs to non-invasive treatment, the classical treatment object is neonatal RDS. While Chang Pin mechanical ventilation has more complications, such as airway, tracheal intubation complications of injury, chronic lung injury, gas leak syndrome, cardiovascular complications, such as infection, ROP, the IVH, this study analyzes 64 cases diagnosed as premature application of neonatal respiratory distress syndrome lung surface active substance joint of two different modes of mechanical ventilation (CPAP and Chang Pin mechanical ventilation) the clinical curative effect of treatment of neonatal respiratory distress syndrome, compared two groups of children with how many complications happened (pneumothorax, bronchial pulmonary hypoplasia, NEC, ROP), total time of be in hospital, the length of the clinical data of the total cost, etc, in order to get a better way of treatment of neonatal respiratory distress syndrome, improve the patient’s cure rate, reduce the incidence of complications and mortality, improve clinical curative effect.Methods:(a) the object of study:on January 1,2012 to December 31,2014 in zaozhuang maternity and child care neonatal intensive care unit, and gestational age less than 32 weeks, a total of 64 patients diagnosed with NRDS premature infants. NRDS clinical diagnostic criteria [4]:(1):fan, shortness of breath, moaning nose, breathe in three concave) such as difficulty breathing; (2) X-ray suggests NRDS. Inclusion criteria: gestational age less than 32 weeks, diagnosed with NRDS, spontaneous breathing. Exclusion criteria:no spontaneous breathing, courtyard have endotracheal intubation, and severe asphyxia, infections, anemia, pulmonary hemorrhage caused by breathing difficulties, heart failure and congenital malformations:a total of 64 cases of children with meet the inclusion criteria, including 40 cases of male patients,24 cases of children with women, the hospitalized days of age less than 30 minutes. It were randomly divided into observation group and control group, each group of 32 cases, mother before delivery using hormones 44 cases, observation group 21 cases,23 cases of control group, extremely low birth weight, a total of 50 cases, observation group of 24 cases, the control group,26 cases of premature rupture of membranes observed group of 27 cases,23 cases of control group, the mother of 8 cases of pih group, control group 24 cases. In comparison with the general data of two groups of children, no significant difference (P> 0.05), no statistical significance, comparable. Research methods 1. The operation steps:to clear the respiratory secretions, children admitted to hospital within 4 h after endotracheal intubation in rapid injection of PS (cosette made Sue, Beijing double crane pharmaceutical companies, dose of 100 mg/kg), gasbag pressurized ventilation (5-10 min), the observation group after application of PS out endotracheal intubation applied n-CPAP (INFANT FLOW SYSTEM, the United States VIASYS HEALTHCARE INC), the control group after application of PS don’t pull out endotracheal intubation directly connected breathing machine (SIMV mode) (NEWPONT e360), children with target oxygen saturation is 85%～ 93%, according to the need to adjust the parameters. N-CPAP evacuation standard for CPAP pressure is less than 4-5 cmh2o, apnoea and bradycardia, SaO2 decreased. Breathing machine out of standard for PIP 10-15 or less cmh2o, PEEP= 2-4 cmh2o, frequency 10 times/min or less, oxygen concentration of 0.4 or less, arterial blood gas, normal into CPAP, or out of breathing machine. Observation group if not make children target oxygen saturation is 85%～93% or flesh is normal, is converted to endotracheal intubation auxiliary breathing breathing machine, to keep the normal target oxygen saturation or flesh.2. Give children with the same routine therapy of two groups, such as thermal, anti-infection, maintain a stable internal environment, parenteral nutrition, etc.(b) Results:1. General situation:two groups of children with gestational age, birth weight and gender ratio and hospital days of age, hospital to use PS time,5 min Apgar score, pregnant mother antenatal corticosteroids, extremely low birth weight, premature rupture of membranes, motherhood gestational hypertension disease, and lung X-ray severity grading differences were no series juice learning significance (P> 0.05). 2.2 set of complications in children with comparison:CPAP group total bronchial dysplasia, hospitalization time, hospitalization cost difference was statistically significant (P< 0.05), pneumothorax, necrotizing enterocolitis, there was no statistically significant difference ROP (all P values> 0.05).Conclusions:Lung surface active material combined application of n-CPAP relative to the combined use of Chang Pin mechanical ventilation treatment of neonatal respiratory distress syndrome, and can reduce the incidence of bronchial pulmonary dysplasia, shorten hospitalization time, reduce hospitalization expenses, but does not reduce the incidence rate of pneumothorax, necrotizing enterocolitis, ROP.