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目的:观察肺表面活性物质(PS)联合机械通气治疗足月儿呼吸窘迫综合征(RDS)的疗效。方法:选取2008年1月至2012年12月信阳市中心医院NICU收治的RDS足月儿66例,根据是否应用PS分为观察组32例和对照组34例。两组患儿均给予维持体温及血压、补充液体及营养管理等支持治疗,机械通气初设模式为“IPPV+PEEP”。观察组于生后2~24 h分三个体位缓慢气管内注入牛肺表面活性剂60~100 mg/kg,同时加压给氧维持血氧饱和度90%~95%,6 h内禁吸痰。对照组未应用PS。观察两组患儿的临床表现、肺功能指标、呼吸机参数、存活率、并发症发生率、肺泡充气程度和机械通气、氧疗及住院时间等。结果:(1)观察组使用PS后动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、动脉-肺泡氧分压比值(a/APO2)、氧合指数(OI)及肺部病理表现较用药前明显改善(P<0.01);(2)观察组机械通气、氧疗和住院时间分别为(5.1±0.5)d、(11.0±1.0)d和(19.0±4.0)d,对照组分别为(9.6±1.5)d、(16.2±3.50)d和(30.7±4.7)d,两组比较差异有统计学意义(P<0.01);(3)观察组死亡3例(9.38%),出现肺炎10例(31.25%)、肺出血2例(6.25%)、颅内出血4例(12.50%)、气胸2例(6.25%),与对照组比较差异无统计学意义(P>0.05)。结论:PS能有效改善足月NRDS患儿肺的通气、换气功能和肺泡充气程度,缩短机械通气时间、氧疗时间和住院时间,降低呼吸机参数,改善预后。
Objective: To observe the efficacy of pulmonary surfactant (PS) combined with mechanical ventilation in treatment of full-term respiratory distress syndrome (RDS). Methods: From January 2008 to December 2012, 64 cases of RDS full-term infants were treated in NICU of Xinyang Central Hospital. According to whether PS was divided into observation group (32 cases) and control group (34 cases). The two groups of children were given supportive measures of maintaining body temperature and blood pressure, supplementing fluids and nutrition management, and the initial mode of mechanical ventilation was “IPPV + PEEP”. In the observation group, bovine pulmonary surfactant 60 ~ 100 mg / kg was slowly intratracheally instilled in three positions 2 ~ 24 h after birth. Meanwhile, oxygen was administered to maintain oxygen saturation of 90% ~ 95% sputum. The control group did not use PS. The clinical manifestations, pulmonary function parameters, ventilator parameters, survival rate, the incidence of complications, alveolar inflatable degree and mechanical ventilation, oxygen therapy and hospital stay were observed in both groups. Results: (1) PaO2, PaCO2, a / APO2, OI and pulmonary pathological changes (P <0.01). (2) The duration of mechanical ventilation, oxygen therapy and hospital stay in the observation group were (5.1 ± 0.5) days, (11.0 ± 1.0) days and (19.0 ± 4.0) days, respectively (9.6 ± 1.5) days, (16.2 ± 3.50) days and (30.7 ± 4.7) days respectively. The difference between the two groups was statistically significant (P <0.01). (3) The death of the observation group was observed in 3 cases Pneumonia was found in 10 cases (31.25%), pulmonary hemorrhage in 2 cases (6.25%), intracranial hemorrhage in 4 cases (12.50%) and pneumothorax in 2 cases (6.25%). There was no significant difference between the two groups (P> 0.05). CONCLUSIONS: PS can effectively improve lung ventilation, ventilatory function and alveolar inflation in NRDS children with full-term treatment, shorten the duration of mechanical ventilation, oxygen therapy and hospitalization, reduce ventilator parameters and improve prognosis.