Value of PS combined with bi-level continuous positive airway pressure in the treatment of preterm infants with NRDS

doi:10.3877/cma.j.issn.1674-6902.2020.06.008

Abstract

Abstract:

Objective

To analyze curative effect of pulmonary surfactant (PS) combined with bi-level continuous positive airway pressure (CPAP) on preterm infants with neonatal respiratory distress syndrome (NRDS) and their influences on pulmonary oxygenation and expression of B cell lymphoma-2 (Bcl-2), cysteine-asparticacidprotease-3 (Caspase-3) and transforming growth factor-β1 (TGF-β1) in bronchoalveolar lavage fluid (BALF).

Methods

The clinical data of 99 NRDS preterm infants who were admitted to neonatal intensive care unit (NICU) of the hospital from February 2016 to March 2019 were retrospectively collected. According to different treatment methods, they were divided into group A (PS + bi-level CPAP, 56 cases) and group B (PS + routine CPAP, 43 cases). The changes of pulmonary oxygenation function under non-invasive respiratory support for different time were compared between the two groups. The non-invasive ventilation time, oxygen support time, hospitalization time, PS usage, tracheal intubation rate and occurrence of related complications were recorded. The expression of Bcl-2, Caspase-3 and TGF-β1 in BALF was measured.

Results

After 12 h and 24 h of starting ventilation, arterial partial pressure of carbon dioxide (PaCO₂) of group A was lower than that of group B. After 12 h of starting ventilation, arterial partial pressure of oxygen (PaO₂) of group A was higher than that of group B. After 12 h, 24 h and 48 h of starting ventilation, fraction of inspired oxygen (FiO₂) in group A was lower than that in group B. After 12 h of starting ventilation, oxygenation index (OI) in group A was higher than that in group B (P<0.05). The oxygen support time of group A was shorter than that of group B, tracheal intubation rate and total incidence of complications were lower than those of group B (P<0.05). After 48 h of starting ventilation, Caspase-3 and TGF-β1 in group A were lower than those in group B, while Bcl-2 was higher than that in group B (P<0.05).

Conclusion

It is safe and effective of PS combined with bi-level CPAP in treatment of preterm infants with NRDS. It can rapidly improve pulmonary oxygenation function, alleviate alveolar inflammation and oxidative damage, shorten oxygen exposure time, and reduce risks of ventilator-related complications.

Key words: Neonatal respiratory distress syndrome, Pulmonary surfactant, Preterm infant, Oxygenation, Bi-level continuous positive airway pressure

Shijun Wen, Yunhuan Zhang, Chengyuan Li. Value of PS combined with bi-level continuous positive airway pressure in the treatment of preterm infants with NRDS[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(06): 755-759.

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Figures/Tables 4

References 23

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组　别	例数	时相	PaO₂(mmHg)	PaCO₂(mmHg)	FiO₂(%)	OI
A组	56	上机前	72.63±6.78	45.26±5.74	81.23±12.63	165.26±37.52
		上机12 h	78.25±7.63^a	42.15±2.79^a	52.36±13.52^a	211.52±12.63^a
		上机24 h	69.85±5.74	37.25±4.14^a	48.63±10.05^a	214.63±30.85
		上机48 h	61.52±5.77	37.98±3.96	40.51±8.76^a	251.56±46.98
B组	43	上机前	73.17±7.56	46.12±5.57	82.35±11.79	167.71±40.68
		上机12 h	70.52±5.41	45.71±3.52	68.63±11.75	198.75±7.96
		上机24 h	68.52±6.77	42.65±4.78	55.74±9.87	210.75±10.99
		上机48 h	62.14±6.25	38.11±5.14	45.63±5.74	239.52±50.07
		F_时间，P_时间	30.044，P<0.001	29.736，P<0.001	55.868，P<0.001	22.939，P<0.001
		F_组间，P_组间	16.214，P<0.001	18.576，P<0.001	38.762，P<0.001	12.239，P<0.001
		F_交互，P_交互	12.732，P<0.001	12.632，P<0.001	24.324，P<0.001	9.768，P<0.001

组　别	例数	时相	PaO₂(mmHg)	PaCO₂(mmHg)	FiO₂(%)	OI
A组	56	上机前	72.63±6.78	45.26±5.74	81.23±12.63	165.26±37.52
		上机12 h	78.25±7.63^a	42.15±2.79^a	52.36±13.52^a	211.52±12.63^a
		上机24 h	69.85±5.74	37.25±4.14^a	48.63±10.05^a	214.63±30.85
		上机48 h	61.52±5.77	37.98±3.96	40.51±8.76^a	251.56±46.98
B组	43	上机前	73.17±7.56	46.12±5.57	82.35±11.79	167.71±40.68
		上机12 h	70.52±5.41	45.71±3.52	68.63±11.75	198.75±7.96
		上机24 h	68.52±6.77	42.65±4.78	55.74±9.87	210.75±10.99
		上机48 h	62.14±6.25	38.11±5.14	45.63±5.74	239.52±50.07
		F_时间，P_时间	30.044，P<0.001	29.736，P<0.001	55.868，P<0.001	22.939，P<0.001
		F_组间，P_组间	16.214，P<0.001	18.576，P<0.001	38.762，P<0.001	12.239，P<0.001
		F_交互，P_交互	12.732，P<0.001	12.632，P<0.001	24.324，P<0.001	9.768，P<0.001

组　别	例数	无创通气时间(d)	氧支持时间(d)	PS应用次数(次)	住院时间(d)	气管插管率[n(%)]
A组	56	6.12±1.78	6.41±2.01	1.05±0.29	20.14±6.23	2(3.57)
B组	43	6.34±1.96	7.61±2.17	1.17±0.32	22.41±7.53	10(23.26)
t/χ²		-0.583	-2.844	-1.951	-1.641	7.096
P值		0.561	0.005	0.054	0.104	0.007^a

组　别	例数	无创通气时间(d)	氧支持时间(d)	PS应用次数(次)	住院时间(d)	气管插管率[n(%)]
A组	56	6.12±1.78	6.41±2.01	1.05±0.29	20.14±6.23	2(3.57)
B组	43	6.34±1.96	7.61±2.17	1.17±0.32	22.41±7.53	10(23.26)
t/χ²		-0.583	-2.844	-1.951	-1.641	7.096
P值		0.561	0.005	0.054	0.104	0.007^a

组　别	例数	呼吸暂停	气胸	脑室内出血	动脉导管未闭	支气管肺发育不良	死亡	总并发症
A组	56	4(7.14)	1(1.79)	1(1.79)	2(3.57)	1(1.79)	0(0)	9(16.07)
B组	43	8(18.60)	2(4.65)	2(4.65)	2(4.65)	3(6.98)	0(0)	17(39.53)
t/χ²值		2.020	0.054	0.054	0.059	0.616	-	6.914
P值		0.155	0.815^a	0.815^a	0.807^a	0.432^a	-	0.008

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