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Background and Purpose: premature children with respiratory distress syndrome (RDS) is a respiratory disease caused by lack of pulmonary surfactant reduced lung compliance and increased work of breathing. Although perinatal therapy technology has increased, but the disease is still the leading cause of death in newborns in the neonatal intensive care unit. Recently, the clinical application of the prevention and treatment of new technology has significantly improved the survival rate of the disease in children. The main measures include: preterm birth risk factors of maternal prenatal glucocorticoid, so as to promote fetal lung maturity; postpartum give indications of neonatal application of exogenous pulmonary surfactant to reduce alveolar surface tension. Numerous clinical studies confirmed that the two measures on the prevention and treatment of premature children respiratory distress syndrome have a significant effect, and the former on the latter synergies. The purpose of this study is to evaluate two measures clinical efficacy of combined treatment of respiratory distress syndrome of premature children is better than any single treatment. Methods and Materials: my hospital NICU in January 2003 to January 2007, 143 patients admitted RDS children were studied retrospectively grouped as follows: Group 1 patients (36 cases with combination therapy of two treatment measures ); 2 group, prenatal maternal application adrenal cortex hormones and postpartum without application of exogenous pulmonary surfactant children (n = 33); Group 3, the application of exogenous pulmonary surfactant while prenatal maternal postpartum not glucocorticoid children (39 cases); Group 4, two measures were not applied to the children (35 cases). Observe and analyze four groups of children with clinical indicators: gender, gestational age, birth weight, mode of delivery, maternal risk factors, Apgar score, children need recovery time and children with perinatal complications. Compare four groups the RDS in children: different HBO (nasal cannula and hood oxygen), end-expiratory pressure ventilation (CPAP) and mechanical ventilation (MV) average duration of treatment, cure and final treatment outcome. SPSS11.0 statistical software, statistical analysis of the data for the chi-square test and analysis of variance, with P <0.05 as a significant difference. Results: 1 general characteristics and clinical indicators: 143 cases the RDS in children in men 93 cases (65.0%), female 50 cases (35.0%). Gestational age in the 26 ~ 38w, mean gestational age was 31.18 ± 0.19w, including gestational age ≤ 32w in children accounted for 74.1%, gestational age> 32w accounted for 25.9%. Birth weight in the 0.84 to 2.79kg, the average weight of 1.55 ± 0.03kg, ≤ 1.5 kg having a children with birth weight accounted for 54.6%, 45.4% weight> 1.5kg in children. Mode of delivery, cesarean section accounted for 66.4%, the natural childbirth 33.6%. Four groups of children with clinical features, gender, gestational age, birth weight, mode of delivery, 1 minute and 5-minute Apgar score, children need recovery time, maternal risk factors and neonatal care conditions no significant statistical analysis difference (p> 0.05). 2 HBO, end-expiratory positive pressure ventilation (CPAP), mechanical ventilation (MV) comparison: 1) nasal cannula: the average nasal cannula time (h), the first group to 75.81 ± 15.63h The second group is 130.09 ± 27.32h, the third group is 150.67 ± 28.59h Group 4 174.32 ± 25.92h. Four groups, a statistically significant difference (p = 0.041). 2) hood oxygen: the average hood oxygen time (h), to 37.16 ± 5.51h in the first group, the second group was 55.29 ± 11.71h, the third group is 62.69 ± 12.39h Group 4 100.75 ± 28.10 h. Four groups, a significant difference (p = 0.047). 3) CPAP: the average CPAP continuous time (h), the first group was 24.33 ± 4.41h and 27.44 ± 4.47h in Group 2, Group 3 to 26.53 ± 3.13h, Group 4 56.50 ± 5.50h. Four groups, a significant difference (p = 0.005). 4) MV: the average MV Time (h), the first group was 56.12 ± 15.65h, the second group is 110.19 ± 21.59h, the third group is 127.79 ± 26.36h, the fourth group 152.61 ± 12.92h. Four groups, a significant difference (p = 0.009, F = 4.173). Group 1 require mechanical ventilation, the number of cases to 16 cases, followed by the second group of 17 cases, Group 3 and Group 4 were 21 cases and 27 cases, suggesting that the severity was significantly higher than that of the four groups of children with RDS other groups (p = 0.034, x ~ 2 test). The average treatment time of 3 four groups of children cured of comparison: the average treatment days for the cure of the first group of children (n = 28) was 15.89 ± 1.29, the average treatment days for cure of the second group of patients (23 cases) and 21.61 ± 2.30, Group 3 children (26 cases) the average number of treatment days cure to 28.31 ± 3.40, Group 4 patients (15 cases) cure the average number of treatment days was 32.73 ± 4.57. Four groups, a significant difference (p = 0.000). 4 four groups of children with final treatment results comparison: group 1 (n = 36), 23 cases (63.89%), RDS cure but there are other complications in 5 cases (13.89%), death in 8 cases (22.22%) completely cured. Group 2 (n = 33), 17 cases (51.52%) were completely cured, RDS cure but there are other complications in 6 cases (18.18%), death in 10 cases (30.30%). Group 3 (n = 39), a complete cure in 14 cases (35.90%), RDS cure but there are other complications in 12 cases (30.77%), death in 13 cases (33.33%). 4 groups (n = 35), completely cured seven cases (20.00%), RDS cure but there are other complications in 8 cases (22.85%), death in 20 cases (57.17%). x ~ 2 test results: i. Four groups: x ~ 2 = 18.421, p = 0.005 (p <0.05) ⅱ. Group 1 and Group 3: x ~ 2 = 6.152, p = 0.046 (p <0.05) ⅲ. Group 1 and Group 4: x to 2 = 14.357, p = 0.001 (p <0.05) ⅳ. Group 1 and Group 2: x ~~ 2 = 1.085, p = 0.581 (p> 0.05) (the proportion of the first group were cured, however, higher than the second group) ⅴ Group 2 and Group 3: the x ~~ 2 = 2.197 , p = 0.333 (p> 0.05) (cured proportion of the second group, however, is higher than the third group) ⅵ Group 2 and Group 4: x to 2 = 7.734, p = 0.021 (p <0.05) VII Group 3 and Group 4: x to 2 = 4.415, p = 0.110 (p> 0.05) (cure proportion of the three groups, however, higher than Group 4) conclusions: 1. PEEP by four groups of respiratory distress syndrome children with HBO, the time required for the duration of mechanical ventilation, the average duration of treatment and cure for the analysis and comparison of the final treatment outcome, can be learned, the combination therapy measures is the most effective, followed by prenatal maternal glucocorticoid and the application of exogenous pulmonary surfactant postpartum, postpartum application of exogenous alveolar surface active substances prenatal maternal not applied adrenal cortex hormones and The two measures were not applied in the treatment less effective. 2. Perinatal intensive care, the adrenal corticosteroids reasonable application, postpartum exogenous pulmonary surfactant substances and auxiliary same period in the way improvements could increase the survival rate of respiratory distress syndrome in children.
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