The Clinical Efficacy Analysis Of The Different First Doses Of Bovine Pulmonary Surfactant Combined With Bipap In Children With NRDS

Objectives:To explore the clinical efficacy of different doses of bovine pulmonary surfactant（PS）combined with bi-level positive airway pressure（Bi PAP）in the treatment of children with neonatal respiratory distress syndrome（NRDS）,and to provide evidence for the treatment of children with NRDS.methods:A total of 153 children with NRDS admitted to the Department of Neonatology and Pediatrics of Fuzhou First People’s Hospital from June 2020 to June 2022 were selected as the study subjects.They were randomly divided into three groups:low,medium,and high dose,with 51 cases in each group.The three groups of children were all delivered in our hospital.The newborns who were transferred to undergraduate treatment immediately after obstetric treatment had no significant difference in their gender,age,gestational age,birth weight,Apgar score 1 min after birth,delivery mode and other basic data.On the basis of comprehensive treatment,Bi PAP was given to patients with clinical manifestations such as respiratory moaning,inspiratory trisomy,and foam sputum vomit at the time of admission.After BIPAP treatment failed,different doses of ps were added,The low dose group was treated with 70 mg/kg of PS,the middle dose group was treated with 100 mg/kg of PS,and the high dose group was treated with 130 mg/kg of PS.Blood gas analysis indicators（PH,PO₂,Pa CO2）and Fi O₂,respiratory support（noninvasive ventilation time,days of oxygen support,twice PS application times,and the incidence of mechanical ventilation within 72 hours）,complications（pneumothorax,pulmonary hemorrhage,hs PDA,IVH,PVL,NEC,BPD,AOP incidence,and mortality）Compare outcomes（cure,effectiveness,and ineffectiveness）and hospitalization（average length of stay,average cost of stay）.Results:1.Before administration,there were no statistically significant differences in p H,Pa O₂,Pa CO₂,and Fi O₂among the three groups of children（P>0.05）.After 6 hours of administration,there were no significant changes in the three blood gas indicators of the three groups（P>0.05）.However,after 24,48,and 72 hours of administration,significant changes began to occur in the three blood gas indicators of the three groups of children,and the differences were statistically significant P<0.05).The p H value and Pa O₂levels of children in the medium and high-dose groups were higher than those in the low-dose group（P<0.05）,while Pa CO₂and Fi O₂indicators were lower than those in the low-dose group（P<0.05）.However,there was no significant difference in the four blood gas indicators between the medium and high-dose groups（P<0.05）.2.The comparison of non-invasive ventilation time,the number of PS applications twice,and the incidence of mechanical ventilation within 72 hours between the three groups was statistically significant（P<0.05）.There was no significant difference in the number of days of oxygen support（P>0.05）.Among them,the non-invasive ventilation time of children in the middle and high dose groups was shorter than that in the low dose group（P<0.05）,the number of children with two PS applications was lower than that in the low dose group（P<0.05）,and the number of cases with 72h mechanical ventilation was lower than that in the low dose group（P<0.05）.However,there was no significant difference between the two groups in the above indicators（P>0.05）.3.The incidences of pneumothorax,pulmonary hemorrhage,hs PDA,IVH,PVL,NEC,and BPD in children in the low dose group were 3.92%,1.96%,7.84%,13.73%,7.84%,5.88%,and 11.76%,respectively,while those in the middle dose group were0.00%,0.00%,9.80%,11.76%,7.84%,7.84%,and 13.73%,and those in the high dose group were 0.00%,0.00%,3.92%,11.76%,3.92%,5.88%,and11.76%,respectively.There was no significant difference in the incidence of complications among the three groups（P>0.05）;There was also no significant difference in the mortality rate among the three groups（3.92%,1.96%,0.00%）（P>0.05）.However,there was a significant difference in the incidence of AOP among the three groups（52.94%、21.5%、23.53%）of children（P<0.05）,and the incidence of AOP in the middle and high dose groups was significantly lower than that in the low dose group（P<0.05）.There was no significant difference between the middle dose group and the high dose group（P>0.05）.4.There were significant differences in the outcome of the three groups of patients,with the good outcome rates in the mid dose group（96.08%）and the high dose group（98.04%）being significantly higher than those in the low dose group（86.27%）,while there was no significant difference between the mid dose and high dose groups（P>0.05）.5.There were significant differences in hospital stay and daily average expenses among the three groups of patients（P<0.05）.Comparison of hospitalization time between the two groups:The hospitalization time in the low dose group was significantly higher than that in the middle and high dose groups（P<0.05）,while there was no significant difference between the high dose group and the middle dose group（P>0.05）;Comparison of daily average costs between the two groups:The treatment costs of the high dose group were higher than those of the low and medium dose groups（P<0.05）,while there was no significant difference between the low and medium dose groups（P>0.05）.Conclusion:Compared with the treatment of PS Combined Bi PAPwith a dose of 70 mg/kg,the treatment effects of PSCombined Bi PAP with a dose of 100 mg/kg and 130 mg/kg are better,that is,high doses of PS within a reasonable range have a better treatment effect on children with NRDS,can effectively reduce the incidence of secondary PS medication and apnea,significantly improve the results of blood gas analysis in children,promote the rehabilitation of children,and have high clinical application value and good safety.