目的 分析鼻塞持续气道正压通气(CPAP)对中晚期早产儿新生儿暂时性呼吸增快(TTN)的治疗效果,为TTN的治疗提供依据。方法 选取2018年3月—2019年2 月在海南医学院第一附属医院新生儿重症监护室(NICU)诊断TTN的中晚期早产儿(32周≤胎龄＜37周)41例,随机分为观察组20例和对照组21例。所有患儿入院后急查肺部超声和胸片,均给予常规治疗,观察组给予鼻塞CPAP通气(FiO₂ 21%,PEEP 4~6 cmH₂O),对照组给予常压空气呼吸,分别记录入院时及治疗后30 min呼吸频率、经皮血氧饱和度、TTN临床评分、住院时间、是否启动应急预案及并发症发生情况。结果 观察组与对照组治疗总有效率、启动应急预案概率、治疗30 min后的TTN临床评分比较,差异有统计学意义(χ²=5.236、8.912,t=-3.042,P<0.05)。观察组与对照组入院时与治疗30 min后呼吸频率、TTN临床评分、经皮血氧饱和度比较,差异有统计学意义(t=5.145、3.608、7.664、5.535、-4.260、-4.891,P<0.05)。两组间并发症发生率比较,差异有统计学意义(P<0.05)。超声诊断TTN的准确率为97.56%。结论 尽早应用CPAP(FiO₂ 21%,PEEP 4~6 cmH₂O)治疗能明显改善TTN患儿的呼吸困难症状,降低用氧概率。超声诊断TTN准确率较高,且安全、无辐射、操作简便,值得在NICU中推广应用。

Objective To investigate the clinical efficacy of nasal continuous positive airway pressure (CPAP) in the treatment of middle and late preterm infants with transient tachypnea of the newborn (TTN),in order to provide evidence for treatment of TTN in children. Methods A total of 41 preterm infants with TTN at gestational age of 32 to 37 weeks were enrolled in this study in the First Affiliated Hospital of Hainan Medical College from March 2018 to February 2019,and were randomly divided into observation group(n=20) and control group(n=21).Both of them took emergency pulmonary ultrasound and chest X-ray,and were treated with conventional therapy.Additionally,the observation group was given nasal CPAP (FiO₂ 21%,PEEP 4~6 cmH₂O),while the control group breathed air in the normal atmospheric pressure.The TTN clinical score,respiratory rate,percutaneous blood oxygen saturation,the hospitalization time,whether to start the emergency plan and complication at admission and after treatment in 30 minutes were compared between the two groups. Results There were significant differences on the total effective rate of treatment,the probability of starting emergency plan and TTN clinical score after 30 minutes of treatment between the observation group and the control group(χ²=5.236,8.912,t=-3.042,P<0.05).And there were significant differences on respiratory frequency,TTN clinical score and percutaneous oxygen saturation in the observation group and the control group (t=5.145, 3.608, 7.664,5.535,-4.260,-4.891,P<0.05).Also,significant difference was found on the incidence of complications between the two groups (P<0.05).The accuracy of ultrasonic diagnosis of TTN was 97.56%. Conclusion s Early application of CPAP (FiO₂ 21%,PEEP 4-6 cmH₂O) can significantly improve the symptoms of dyspnea in TTN premature infants and reduce the probability of oxygen use.The accuracy of ultrasonic diagnosis of TTN is high,ultrasonic testing is safe,radiation-free and easy to operate,which is worthy of promotion and application in NICU.