Abstract:

Objective　To explore the application value of nursing intervention under the mode of graded airway management in neonates with hyaline membrane disease (HMD) treated by nasal continuous positive airway pressure (NCPAP) ventilator. Methods　It was a prospective randomized controlled trial. A total of 94 neonates with HMD in Shangqiu First People's Hospital from March 2018 to June 2022 were selected and were divided into a study group (47 cases) and a routine group (47 cases) according to different nursing methods. In the routine group, there were 26 males and 21 females, with a gestational age of (33.11±1.20) weeks; in the study group, there were 23 males and 24 females, with a gestational age of (32.95±1.06) weeks. The routine group received routine nursing intervention, while the study group received nursing intervention under the mode of graded airway management on the basis of the routine group. The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, blood gas indexes [arterial partial pressure of carbon dioxide (PaCO₂), tidal volume (VT), oxygenation index (PaO₂/FiO₂), and arterial partial pressure of oxygen (PaO₂)], mechanical ventilation time, hospital stay, and complication rate were compared between the two groups. t test, χ² test, and Fisher exact probability method were used for statistical analysis. Results　After intervention, the APACHEⅡ score of the study group was lower than that of the routine group [(11.42±2.05) points vs. (14.73±3.18) points], with a statistically significant difference (t=5.998, P<0.001). After intervention, the PaCO₂, VT, PaO₂/FiO₂, and PaO₂ in the study group were (39.87±3.25) mmHg (1 mmHg = 0.133 kPa), (508.36±15.73) ml, (195.36±13.65), and (86.36±4.20) mmHg, respectively, which were higher than those in the routine group [(35.43±2.08) mmHg, (457.92±13.42) ml, (178.61±10.03), and (77.14±3.62) mmHg], with statistically significant differences (all P<0.001). The duration of mechanical ventilation and hospital stay in the study group were (6.25±1.17) d and (8.62±1.53) d, respectively, which were both shorter than those in the routine group [(8.73±1.38) d and (11.36±1.76) d], with statistically significant differences (t=9.397 and 8.055; both P<0.001). The total incidence of complications in the study group was lower than that in the routine group [0 vs. 12.77% (6/47)], with a statistically significant difference (P=0.026). Conclusion　Nursing intervention under the mode of graded airway management can promote the recovery of HMD neonates treated by NCPAP, correct their blood gas values, reduce the risk of complications, and further improve the prognosis.

Key words:

Hyaline membrane disease, Neonates, Nasal continuous positive airway pressure, Graded airway management

摘要：

目的　探讨气道分级管理模式下的护理干预在鼻塞式持续气道正压通气（NCPAP）呼吸机治疗的肺透明膜病（HMD）新生儿中的应用价值。方法　本研究为前瞻性随机对照试验。选取商丘市第一人民医院2018年3月至2022年6月就诊的HMD新生儿94例，根据护理方法不同分为研究组和常规组，每组47例。常规组男26例，女21例，胎龄（33.11±1.20）周，给予常规护理干预；研究组男23例，女24例，胎龄（32.95±1.06）周，在常规组基础上联合气道分级管理模式下的护理干预。比较两组急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、血气指标［动脉血二氧化碳分压（PaCO₂）、潮气量（VT）、氧合指数（PaO₂/FiO₂）、动脉血氧分压（PaO₂）］、机械通气时间、住院时间、并发症发生率。统计学方法采用t检验、χ²检验、Fisher确切概率法。结果　干预后研究组的APACHEⅡ评分低于常规组［（11.42±2.05）分比（14.73±3.18）分］，差异有统计学意义（t=5.998，P<0.001）；干预后研究组的PaCO₂、VT、PaO₂/FiO₂、PaO₂分别为（39.87±3.25）mmHg（1 mmHg=0.133 kPa）、（508.36±15.73）ml、（195.36±13.65）、（86.36±4.20）mmHg，均高于常规组的（35.43±2.08）mmHg、（457.92±13.42）ml、（178.61±10.03）、（77.14±3.62）mmHg，差异均有统计学意义（均P<0.001）；研究组机械通气、住院时间分别为（6.25±1.17）d、（8.62±1.53）d，均短于常规组的（8.73±1.38）d、（11.36±1.76）d，差异均有统计学意义（t=9.397、8.055，均P<0.001）；研究组并发症总发生率低于常规组［0比12.77%（6/47）］，差异有统计学意义（P=0.026）。结论　气道分级管理模式下的护理干预可促进NCPAP HMD新生儿病情恢复，纠正其血气值，降低并发症发生风险，并进一步改善预后。

关键词:

肺透明膜病, 新生儿, 鼻塞式持续气道正压通气, 气道分级管理