Objective To compare the effect of noninvasive ventilation (nasal continuous positive airway pressure ventilation,-NCPAP) and nasal intermittent positive pressure ventilation,-NIPPV) and invasive ventilation (i.e.,mechanical ventilation,CMV) combined with pulmonary surfactant (PS) in the treatment of Ⅰ ～ Ⅲ level in premature infants with respiratory distress syndrome (NRDS).Methods 81 cases with Ⅰ ～ Ⅲ level in NRDS were selected.40 cases in invasive group was given CMV combined with PS therapy.41 cases in noninvasive group was given noninvasive ventilation combined with PS therapy.The changes of blood gas,cure rate,complications,duration of oxygen therapy,hospitalization expenses and time were compared between the two groups.Results 1 hour after treatment,clinical symptoms were obviously improved in the two groups.6 hours,12 hours,weaning of blood gas analysis of two groups to maintain arterial oxygen partial pressure (PaO2) better and showed an upward trend,arterial partial pressure of carbon dioxide (PaCO2) was decreased,while the two groups before and after treatment had no significant differences (P ＞ 0.05).The cure rate of noninvasive group was 95.0％,that in invasive group was 92.5 ％,the difference between the two groups was not significant (P ＞ 0.05).Compared with the invasive group,the infection rate of lung,the incidence rate of chronic lung disease in noninvasive group were significantly lower (22.0％ vs 65.0％、14.6％ vs 37.5 ％,x2 =6.243,6.021,all P ＜ 0.01),the duration of oxygen therapy,time of hospitalization in the noninvasive group were significantly shorter (t =3.092,3.070,P ＜ 0.05),and the hospital costs was relatively low (t =3.791,P ＜ 0.05).Conclusion Noninvasive ventilation combined with PS in the treatment of Ⅰ ～ Ⅲ level NRDS is safe,efficient,relative economic,it is worthy of popularization,especially in primary hospital.