Clinical Study On The Treatment Of Neonatal Respiratory Distress Syndrome With Pulmonary Surfactant Combined With Different Respiratory Support Methods

Objective:To investigate the difference of curative effect and early complication rate of PS combined with different respiratory support in treatment of NRDS.Methods:Using retrospective methods,Ninety-five premature infants diagnosed with NRDS,admitted to the The First Affiliated Hospital of Dali University from June 2019to December 2022 were selected as the study objects.According to the breathing support method,there were 25 INSURE technical groups and 70 MV groups.The children in the INSURE technique group underwent endotracheal intubation,injected PS,and removed the endotracheal tube for NCPAP treatment.MV group was treated with PS after endotracheal intubation without removal of endotracheal catheter.The PH value,Pa O₂,Pa CO₂,mortality,incidence of BPD,incidence of pneumothorax,rate of re-use of PS,case fatality rate,hospitalization cost and other indicators of the two groups were compared and analyzed by statistical methods.Results:There were no significant differences in baseline data of gender,fecal amniotic fluid staining,gestational age,cesarean section,birth weight and prenatal hormone use between the two groups（all P>0.05）.In the MV group,the percentages of grade 3 to 4chest X-rays,mothers with hypertension during pregnancy,and mothers with diabetes during pregnancy were higher than those in the INSURE group（81.4%vs.56%,45.7%vs.20.0%,24.2%vs.4.0%,all P<0.05）.Apgar scores in the MV group at 1min,5min and 10min after birth were lower than those in the INSURE technical group[6（4,8）vs.7（6,8）,7（5,8）vs.8（7,9）,7（6,9）vs.8（8,9）,all P<0.05].After 1h combined with PS,PH values of both groups were higher than those before combined with PS（MV group:7.3±0.1 vs.7.2±0.1,INSURE technical group:7.3±0.1 vs.7.2±0.1,both P<0.05）.And Pa CO₂was lower than that before PS administration（MV group:37.6±12.5vs.54.3±13.1,INSURE technical group:41.5±9.8 vs.48.3±14.1,P<0.05）.However,there was no difference in PH values,Pa O₂and Pa CO₂between the two groups before and after combined PS treatment.The composition ratio of 5min Apgar score in the MV group was significantly lower than that in the INSURE technical group（≤3 points:8.6%vs.0%,4-7 points:51.4%vs.28.0%,8-10 points:40.0%vs.72.0%,all P<0.05）.The rates of BPD and PS re-use in premature infants in MV group were higher than those in INSURE group（47.1%vs.20.0%,37.1%vs.12.0%,all P<0.05）.However,the incidence of pneumothorax（4.3%vs.4.0%）,incidence of pulmonary hemorrhage（4.3%vs.0%）,mortality（25.7%vs.20.0%）,length of stay（30.9±23.4 vs.28.3±16.7）and hospitalization cost（53855.0±90686.7 vs.32996.4±18307.0）were not consistent between the two groups（P>0.05）.The failure rate of the INSURE technical group was16.0%.Conclusions:1.MV should be selected for premature infants with NRDS who have low Apgar score 5min after birth,heavy chest X-ray degree and many complications during pregnancy.2.PS combined with MV and INSURE technique could significantly improve the respiratory function of NRDS premature infants,and there were no differences in mortality,hospitalization cost and length of stay between the two groups.3.INSURE technique can reduce the incidence of BPD and the re-use rate of PS in premature infants with NRDS,but the failure rate is 16.0%.