大剂量盐酸氨溴索联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征

Therapeutic Effect of Large Dose Mucosolvan Combined Variant Flow Rate Continuous Positive Airway by Nasal Mask on Neonatal Respiratory Distress Syndrome

目的 探讨大剂量盐酸氨溴索（沐舒坦）联合新型鼻罩持续呼吸道正压通气治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法选择NRDS患儿114例，随机分成治疗组（n=58）和对照组（n=56），两组在相同综合治疗的基础上，对照组予头罩吸氧（氧流量4～6L／min），治疗组予大剂量沐舒坦30mg／（1kg·d），分2次用5％葡萄糖注射液20mL稀释后静脉滴注，并联合新型鼻罩持续呼吸道正压通气（NCPAP），其参数设定为流量6～8L／min，吸人氧浓度（FiO2）0．4～0．6，压力为5-8cm H2O，观察两组治疗后12及48h的临床表现及血气变化，比较pa（O2）及pa（CO2）及pa（O2）／FiO2的变化。结果治疗组44例经治疗12h及48h后，呼吸困难和呻吟明显减轻或消失，血pa（O2）升高，pa（CO2）下降，氧合参数明显增加，其中以胸片RDS分级Ⅰ及Ⅱ级效果较佳，Ⅲ及Ⅳ级效果较差；治疗组总有效率75．8％，而对照组为26．7％，两组疗效及血气、氧合指数比较均有显著性差异。结论大剂量沐舒坦联合新型鼻罩持续呼吸道正压通气能改善通气及氧合，对新生儿RDS有较好的疗效，尤其对胸片RDS分级Ⅰ级及Ⅱ级的患儿，早期应用可避免气管插管。减少机械通气率。

Objective To investigate the therapeutic effect of large dose mueosolvan combined variant flow rate continuous positive airway by nasal mask on neonatal respiratory distress syndrome（NRDS）. Methods One hundred and fourteen newborns with NRDS were randomly divided into treatment group（58 cases） and control group（56 cases） ,on the base of same combined therapy , the cases in control group only underwent oxygen-absorbing by head set with the flow rate 4 - 6 L/min, and the cases in treatment group were given large dose mueosolvan（Ambroxol Hydrochloride） 30 mg/（kg·d） ＋ 5%GS 20 mL, for two times and variant flow rate continuous positive airway by nasal mask（NCPAP）, the parameter setting flow rate 6-8 L/min, FiO2 0.4-0.6, pressure 5-8 cm H2O. The clinical symptom and blood gas analysis after 12 and 48 hours were observed and compared the changes of pa（O2 ）, pa（CO2 ）, pa（O2 ）/FiO2 in two groups. Results The dyspnea and groan in 44 cases in the treatment group lessoned or vanished, pa（O2 ） rised and pa（CO2 ） lowered, the oxygenation index obviously increased, the cases with RDS grade Ⅰ and grade Ⅱ had better therapeutic effect, and the cases with RDS grade Ⅲ （X -ray）and Ⅳ had not manifest effect, the total effective rate was 75.8% in treatment group and 26.7% in control group. There were significant difference in therapeutic effect and oxygenation index between two groups. Condusiom Large dose mueosolvan combining variant flow rate continuous positive airway by nasal mask can significantly improve the ventilation and oxygenation function and there are significant therapeutic effect in NRDS, especially in the NRDS grade Ⅰ and grade Ⅱ , the trachea cannula may be avoided and mechanical ventilation rate may be decreased if the therapeutic method can be used in earlier period.