肺表面活性物质的临床运用与新生儿肺透明膜病的转归

Application of pulmonary surfactant and prognosis of hyaline membrane disease

目的:探讨肺表面活性物质(PS)治疗新生儿肺透明膜病(HMD)的疗效及对其转归的影响。方法:对17例HMD患儿气管内给予PS,观察用药后的临床表现、呼吸机参数、血气分析结果、胸片的变化,分析其疗效、并发症及转归。结果:用药后临床症状和体征改善。机械通气参数PIP、PEEP、MAP、RR明显降低;血气分析PaO2及pH值明显上升,PaCO2明显下降,与用药前相比差异有极显著性(P<0.01)。24h胸片提示肺部病变明显改善。肺出血、颅内出血及硬肿症等并发症的发生率较对照组明显降低(P<0.05)。结论:PS治疗HMD可明显改善其转归,减少上机时间、住院天数及死亡率。

Objective To explor e effect and pathological o f pulmonary surfactant (PS)replacement therapy in hy aline membrane disease(HMD)of neonate.Methods The pulmonary surfactant was a dmitt ed to seventeen neonates with hyaline membrane disease,then obse rve the changes of clinical manifestations,parameter of mechanical,th e results of blo od gas,X-ray presentations in lung after administration.Analyze the effe ct o f therapy prognosis and complica tion.Results After medical treatment,the symp to ms and signs were improved.The pressure peak of mechanical aeration para met er(PIP),positive breath pressure(PEEP),average gas trace pressure(MAP)an d breath frequent (RR)dropped remarkably(P<0.01).The lever of PaO 2 and pH were increased obviously,and the lever of PaCO 2 was dropped obviously.The differen ce between before and after medical tre atment was very remarkably(P<0.01).At 24hours after treatment,X-ray presentations were turned better.T here were significance difference i n pulmon ary hemorrhage,sclerema neonatorum and intracranial hemorrhage incidence.Concl usion The pulmonary surfactant can improv e hyaline membrane disease pathologica l change;reduce time of respirator utilization,days of hospital stay and death rate.[