肺表面活性物质联合鼻塞式持续气道正压通气治疗新生儿肺透明膜病的临床观察  

Clinical observation of pulmonary surfactant combined with nasal continuous positive airway pressure ventilation in the treatment of neonatal hyaline membrane disease

作　　者：赵燕 杨宝英 和旭盟 Zhao Yan;Yang Baoying;He Xumeng(Department of Pediatrics,Nujiang Prefecture People's Hospital,Yunnan Province,Nujiang,Yunnan,673100,China)

机构地区：[1]云南省怒江州人民医院儿科,云南怒江673100

出　　处：《当代医学》2019年第11期30-33,共4页Contemporary Medicine

摘　　要：目的观察分析肺表面活性物质(PS)联合鼻塞式持续气道正压通气(NCPAP)治疗新生儿肺透明膜病(HMD)的临床效果。方法将2017年6月至2018年6月本院新生儿科收治的120例HMD患儿随机分为对照组和观察组,各60例,对照组患儿给予常规治疗措施,观察组在常规治疗的基础上采用PS联合NCPAP进行治疗,比较分析两组患儿治疗前、治疗后6 h、治疗后12 h及治疗后24 h 4个时间点血气分析结果,观察比较两组的并发症发生率以及治疗前和治疗3 d后的呼吸力学指标,包括静态肺顺应性(Cstat)、吸气峰流量(Insp Flow)、呼吸时间常数(RCexp)。结果两组患儿治疗前PaO2、PaCO2和SpO2等血气分析指标对比差异均无统计学意义;治疗后6 h、12 h及24 h两组患儿PaO2、PaCO2和SpO2值均逐渐改善,且观察组较对照组各项指标改善更加显著,差异均有统计学意义(P<0.05)。两组患儿治疗前Cstat、Insp Flow和RCexp值比较,差异均无统计学意义;经过治疗后,两组患儿Cstat、Insp Flow均显著高于治疗前(P<0.05),且观察组优于对照组(P<0.05)。观察组患儿在治疗期间呼吸机相关性肺炎、肺损伤以及气漏发生率均明显低于对照组,差异具有统计学意义(P<0.05)。结论 PS联合NCPAP治疗HMD患者的临床疗效显著,可以有效的改善患儿的血气分析与呼吸力学指标,并发症发生率低,值得临床推广使用。Objective To observe and analyze the clinical effect of pulmonary surfactant(PS)combined with nasal continuous positive airway pressure(NCPAP)in the treatment of neonatal hyaline membrane disease(HMD).Methods Total of 120 children with HMD admitted to neonatal department of our hospital from June 2017 to June 2018 were randomly divided into control group and observation group,60 cases in each group.The control group was given routine treatment,and the observation group was treated with PS combined with NCPAP on the basis of routine treatment.The blood gas analysis results of the two groups before treatment,6 hours after treatment,12 hours after treatment and 24 hours after treatment were compared and analyzed.The incidence of complications and respiratory mechanics indexes including static lung compliance(Cstat),peak inspiratory flow(Insp Flow)and respiratory time constant(RCexp)were compared before and after treatment.Results There was no significant difference in blood gas analysis indexes such as PaO2,PaCO2,and SpO2 between the two groups before treatment.The PaO2,PaCO2 and SpO2 values of the two groups gradually improved after 6,12 and 24 hours of treatment,and the improvement of each index in the observation group was more significant than that in the control group,the difference was statistically significant(P<0.05).There was no significant difference in the values of Cstat,Insp Flow and RCexp between the two groups before treatment.After treatment,the values of Cstat and Insp Flow in the two groups were significantly higher than those before treatment(P<0.05),and the observation group was better than the control group(P<0.05).The incidence of ventilator-associated pneumonia,lung injury and air leakage in the observation group was significantly lower than that in the control group during the treatment period(P<0.05).Conclusion The methods of PS combined with NCPAP in the treatment of HMD has a significant clinical effect,which can effectively improve the blood gas analysis and respiratory mechanics of child

关 键 词：新生儿肺透明膜病 肺表面活性物质 鼻塞式持续气道正压通气 

分 类 号：R722.1[医药卫生—儿科]