外源性肺表面活性物质对早产儿张力性气胸肺功能的影响  

The efficacy of pulmonary surfactant for pulmonary function in premature tension pneumothorax

作　　者：刘淑华[1] 申月波[1] 刘翠青[1] 马莉[1] 

机构地区：[1]河北省儿童医院新生儿科,河北石家庄050031

出　　处：《发育医学电子杂志》2017年第3期146-151,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：河北省医学适用技术跟踪项目(G201745)

摘　　要：目的探讨外源性肺表面活性物质(pulmonary surfactant,PS)对早产儿张力性气胸肺功能的影响。方法选择2012年6月至2015年12月在河北省儿童医院新生儿重症监护病房住院的52例合并张力性气胸的早产儿为研究对象,随机分为PS治疗组(27例)与对照组(25例)。PS治疗组在胸腔闭式引流后1~3小时内应用PS气管内注入,记录此时及此后1、12、24、48、72小时及撤机时的肺顺应性(Cydn)、气道阻力(Raw)及平均气道压(MAP),计算动脉/肺泡氧分压比值(a/APO_2),统计胸腔闭式引流应用时间、氧暴露时间、机械通气时间、住院时间以及并发症。结果两组Raw、MAP随时间变化逐渐下降,Cydn、a/APO_2值则逐渐升高。组间比较显示:应用PS后1小时,PS治疗组的a/APO_2高于对照组;12小时其Cydn高于对照组,而Raw、MAP低于对照组,差异均有统计学意义(P﹤0.05)。组内比较显示:PS治疗组的a/APO_2、Cydn分别在1小时、12小时升高,MAP、Raw分别在1小时、12小时降低,差异均有统计学意义(P﹤0.05)。对照组直至24小时,a/APO_2、Cydn、Raw的改变差异才有统计学意义(P﹤0.05)。PS治疗组与对照组的高氧暴露时间(FiO_2≥40%)分别为(56±18)与(74±29)小时,总氧暴露(FiO_2﹥21%)时间分别为(157±29)与(177±36)小时,机械通气时间分别为(128±41)与(151±30)小时,胸腔闭式引流管留置时间分别为(78±29)与(114±36)小时,PS组均较低,差异有统计学意义(P﹤0.05)。结论早产儿张力性气胸时,在胸腔闭式引流后及早应用PS,可使被压迫损伤的肺组织较快恢复肺功能,改善患儿预后。Objective To investigate the effect of pulmonary surfactant（PS） for the treatment of premature tension pneumothorax. Methods Eligible patients diagnosed as tension pneumothorax admitted consecutively to the neonatal intensive care unit（NICU） of the Children’s Hospital of Hebei Province from June 2012 to December 2015 were included in the study. The patients with tension pneumothorax were randomized in a random number table method to PS group（n=27） and control group（n=25）. All patients were treated in the same neonatal unit and received the same standard therapy throughout the study period. The patients in PS group received PS endotracheal intubation within 1-3 hours after the application of chest drainage. At the same time, Cydn, resistance in airway（Raw）, mean airway pressure（MAP）, a/APO2 were recorded at 0, 1, 12, 24, 48, 72 h and before evacuation of breathing machine. Chest drainage application time, oxygen exposure time, mechanical ventilation time, hospital stays and complications were also recorded. Results Raw and MAP in two groups were gradually decreased, a/APO2 and Cydn were increased. Result of comparison between two groups showed that, 1 h after using PS, a/APO2 of PS group was higher than that of control group; 12 h after using PS, Cydn of PS group was higher than that of control group; but the Raw and MAP of PS group were lower than those of the control group and there were statistical significances（P﹤0.05）. Comparison in groups showed that, a/APO2 and Cydn of PS group were increased at 1 h and 12 h respectively, but MAP and Raw were decreased at 1 h and 12 h respectively（all P﹤0.05）. The a/APO2, Cydn, Raw between PS group and control group were statistically different（P﹤0.05） until 24 h. Exposure time of high concentration oxygen（FiO2≥40%） of PS group and control group were（56±18） and（74±29） h, total oxygen exposure（FiO2﹥21%） time were（157±29） and（177±36） h, ventilation time were（128±41） and（151±30） h, chest drai

关 键 词：张力性气胸 肺表面活性物质 早产儿 肺功能 

分 类 号：R722.6[医药卫生—儿科]