牛肺表面活性剂辅助无创持续气道正压通气治疗新生儿呼吸窘迫综合征的临床疗效  

Clinical efficacy of bovine lung surfactant assisted noninvasive continuous positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome

作　　者：付小梅 陈秋月 段光敏[1] FU Xiaomei;CHEN Qiuyue;DUAN Guangmin(Department of Pediatrics,Neijiang First People′s Hospital,Neijiang 646000,China)

机构地区：[1]四川省内江市第一人民医院儿科,646000

出　　处：《临床合理用药杂志》2022年第18期26-29,33,共5页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的 观察牛肺表面活性剂辅助无创持续气道正压通气治疗新生儿呼吸窘迫综合征的临床疗效。方法 回顾性选取2019年11月-2020年11月内江市第一人民医院收治的经无创持续气道正压通气治疗的新生儿呼吸窘迫综合征患儿47例作为对照组,另选取本院同期经牛肺表面活性剂辅助无创持续气道正压通气治疗的新生儿呼吸窘迫综合征患儿47例作为研究组。2组均治疗24 h后观察疗效。比较2组治疗前、治疗24 h后血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压/吸入氧分数(PaO_(2)/FiO_(2))、p H值]、呼吸机参数[呼吸频率、平均气道压(MAP)、呼气末正压通气(PEEP)、气道峰压(PIP)]、血清学指标[骨形态发生蛋白-7(BMP-7)、铁蛋白(SF)、促肾上腺皮质激素(ACTH)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)]及并发症。结果 治疗24 h后,2组PaCO_(2)低于治疗前,PaO_(2)、PaO_(2)/FiO_(2)、p H值高于治疗前,且研究组PaCO_(2)低于对照组,PaO_(2)、PaO_(2)/FiO_(2)、p H值高于对照组(P<0.01)。治疗24 h后,2组呼吸频率、MAP、PEEP、PIP低于治疗前,且研究组低于对照组(P<0.01)。治疗后,2组BMP-7、TNF-α、CRP低于治疗前,SF、ACTH高于治疗前,且研究组BMP-7、TNF-α、CRP低于对照组,SF、ACTH高于对照组(P<0.01)。研究组肺部感染、支气管肺发育不良、呼吸暂停发生率低于对照组(P<0.05);2组肺出血发生率比较,差异无统计学意义(P>0.05)。结论 牛肺表面活性剂辅助无创持续气道正压通气治疗新生儿呼吸窘迫综合征的临床疗效确切,可有效改善患儿的肺换气功能与血气分析,减轻炎性反应,预防肺部受损,提高肺部顺应性,降低并发症发生率。Objective To analyze the clinical efficacy of bovine lung surfactant assisted noninvasive continuous positive airway pressure ventilation in the treatment of neonatal respiratory distress syndrome.Methods Forty-seven cases of neonatal respiratory distress syndrome treated by noninvasive continuous positive airway pressure in Neijiang First People’s Hospital from November 2019 to November 2020 were retrospectively selected as the control group,47 cases of neonatal respiratory distress syndrome treated with bovine lung surfactant and noninvasive continuous positive airway pressure were selected as the study group.The curative effect was observed after 24 hours of treatment in the two groups.Blood gas indexes(PaO_(2),PaCO_(2),PaO_(2)/FiO_(2),p H value),ventilator parameters(respiratory rate,MAP,PEEP,PIP),serological indexes(BMP-7,SF,ACTH,TNF-α,CRP) before and 24 hours after treatment and incidence of complications were compared between the two groups.Results After 24 hours of treatment,PaCO_(2)in the two groups was lower than that before treatment,while PaO_(2),PaO_(2)/FiO_(2)and p H value were higher than those before treatment,and PaO_(2)in the study group was lower than that in the control group,PaO_(2),PaO_(2)/FiO_(2)and p H value were higher than those in the control group(P<0.01).After 24 hours of treatment,the respiratory rate,MAP,PEEP and PIP of the two groups were lower than those before treatment,and the study group were lower than those in the control group(P<0.01).After treatment,BMP-7,TNF-αand CRP in the two groups were lower than those before treatment,while SF and ACTH were higher than those before treatment,and BMP-7,TNF-αand CRP in the study group were lower than those in the control group,while SF and ACTH were higher than those in the control group(P<0.01).The incidence of pulmonary infection,bronchopulmonary dysplasia and apnea in the study group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of pulmonary hemorrhage between the two gro

关 键 词：新生儿呼吸窘迫综合征 牛肺表面活性剂 无创持续气道正压通气 治疗结果 血气指标 

分 类 号：R722.1[医药卫生—儿科]