辅佐纳洛酮抢救新生儿肺出血的疗效研究

Clinical observation and exploration of applying naloxone in the treatment of pulmonary hemorrhage in newborn infants

目的:探讨辅佐纳洛酮抢救新生儿肺出血的疗效.方法: 对确诊的56例新生儿肺出血患儿,随机分为常规组23例和观察组33例.常规组给予气管插管、1∶10000肾上腺素气管内冲洗、立止血0.5 ku静脉注射同时气管内滴入0.3～0.5 ku及机械通气,同时治疗原发病、去除诱因、抗感染、纠正酸中毒及水电解质酸碱紊乱、维持正常血糖、抗休克、确保组织灌注良好及防止再灌注损伤等综合治疗.观察组:在常规治疗的基础上辅佐纳洛酮治疗.结果:观察组治愈25例,死亡8例,病死率为 24.2%,平均肺出血缓解时间为(9.20±4.45) h;常规组治愈11例,死亡 12例,病死率为52.1%,平均肺出血缓解时间(13.35±7.03) h.两组病死率和平均肺出血缓解时间比较,均有显著性差异(χ2＝4.010,P<0.05及t＝2.708,P＜0.01.结论:辅佐纳洛酮抢救新生儿肺出血可缩短病程,提高疗效,降低病死率.该疗法经济,简便,为抢救新生儿肺出血开辟了新途径.

Objective To evaluate the protect role of naloxone in the treatment of neonatal pulmonary hemorrhage. Methods Fifty-six cases were divided into 33 cases of observation group and 23 cases of routine group. In the routine group, patients were intubated immediately as soon as diagnosed. Then 1∶10000 epinephrine was dropped into the lung through the intubatton. Reptilase was used by two ways： dropped through the intubation and injected in vein. At last mechanical ventilation was adopted with high positive end-expiratory pressure（PEEP）. In the observation group, on the basis of the measures mentioned in routine group naloxone was dropped in vein as assistant treatment with a dose at 0. 4-0. 8mg diluted in 10% glucose. If the hemorrhage was serious. Naloxone was injected directly in vein with a dose at 0.1-0.4 mg also diluted in 10% glucose firstly and followed by dropping. The period of treatment was 3-4 days. Results The mortality in observation group （25 cases were survived and 8 cases died, mortality （24.2%） was lower than those of routine group （11 cases were survived and 12 cases died, mortality 52.1%）, （χ^2=4.010）. In observation group the average remission time of pulmonary hemorrhage was significantly shorter than those of routine group （9.20±4.45）h vs （13.35±7.03） h; t=2.708, P〈0.01. Conclusion The assistance use of naloxone not only can decrease the average remission time of pulmonary hemorrhage but also increase the rates of survival and cure infants. So naloxone can give clear curative effect in treatment of neonatal pulmonary hemorrhage by means of resisting β-endorphin, improving ventilation, restraining and getting rid of the free radical and the lung tissue.