地塞米松治疗重度新生儿急性呼吸窘迫综合征临床疗效研究  

Clinical efficacy of dexamethasone in treatment of severe neonatal acute respiratory distress syndrome

作　　者：白瑞苗 杨冬 李清红 柯华 李占魁 郭金珍 曾军安 BAI Ruimiao;YANG Dong;LI Qinghong;KE Hua;LI Zhankui;GUO Jinzhen;ZENG Jun’an(Northwest Women’s and Children’s Hospital,Xi’an 710061,China)

机构地区：[1]西北妇女儿童医院,陕西西安710061

出　　处：《陕西医学杂志》2022年第2期235-238,共4页Shaanxi Medical Journal

摘　　要：目的:评价地塞米松治疗重度新生儿急性呼吸窘迫综合征(NARDS)的安全性及有效性。方法:回顾分析依据NARDS蒙特勒标准(2017年版)分度为重度的NARDS患儿85例,随机分为两组:干预组41例、对照组44例,所有患儿均接受高频震荡通气、肺泡表面活性物质替代、一氧化氮吸入治疗以及其他综合治疗,在以上治疗的基础上干预组给预静脉使用地塞米松治疗,对照组未使用地塞米松治疗,比较两组患儿治疗前后血气结果、并发症以及病死率。结果:两组患儿一般资料、围产期资料及初次上机时间比较,差异均无统计学差异(均P>0.05);两组患儿用药之前动脉血气结果以及氧合指数(OI)比较差异均无统计学差异(均P>0.05),用药之后干预组pH值改善更明显,OI指数下降更快,两组比较差异有统计学差异(均P<0.05);干预组病死率小于对照组,两组比较差异有统计学差异(P<0.05);干预组气漏及肺出血发生率、总机械通气时间、一氧化氮吸入时间、住院时间与对照组比较差异无统计学意义(均P>0.05)。结论:地塞米松治疗重度NARDS可以改善患者血气及氧合指数,降低病死率,无不良近远期并发症发生。Objective:To evaluate the safety and effectiveness of dexamethasone in the treatment of severe neonatal acute respiratory distress syndrome(NARDS).Methods:85 patients with severe NARDS according to NARDS Montreux standard(2017 version)were retrospectively analyzed and randomly divided into two groups:41 patients in the intervention group and 44 patients in the control group.All patients received high-frequency oscillatory ventilation,alveolar surfactant replacement,nitric oxide inhalation and other comprehensive treatment.On the basis of the above treatment,the intervention group was treated with intravenous dexamethasone,and the control group was not treated with dexamethasone.The blood gas results,complications and mortality of the two groups before and after treatment were compared.Results:There was no statistical difference in general data,perinatal data,and first time on the computer between the two groups(all P>0.05).There was no significant difference in arterial blood gas results and oxygenation index(OI)before medication between the two groups(all P>0.05).After medication,the pH value improved more significantly and OI index decreased faster in the intervention group,and there was significant difference between the two groups(all P<0.05).The mortality of the intervention group was lower than that of the control group(P<0.05).There was no significant difference in the incidence of air leakage and pulmonary hemorrhage,total mechanical ventilation time,nitric oxide inhalation time and hospital stay between two groups(all P>0.05).Conclusion:Dexamethasone in the treatment of severe NARDS can improve blood gas and oxygenation index,reduce mortality,and have no adverse short-term and long-term complications.

关 键 词：重度新生儿急性呼吸窘迫症 治疗 地塞米松 高频震荡通气 氧合指数 安全性 

分 类 号：R568.3[医药卫生—呼吸系统]