肺表面活性物质与机械通气联合治疗肺透明膜病的疗效评价

Combination of pulmonary surfactant and mechanical ventilation to treat new-born infants hyaline membrane disease.

目的 评价基层医院应用肺表面活性物质（PS）与机械通气联合治疗新生儿肺透明膜病（HMD）的疗效.方法 治疗组在上呼吸机及常规治疗12 h内给于PS,将传统方法改为快速注入间歇给药法;首剂给药量：150～200 mg/kg,重复给药量100 mg/kg.主要疗效评价指标：用PS后不同时期的氧合指数（OI）和动脉/肺泡氧分压（a/A PO2）变化及临床症状改善情况;次要疗效评价指标：机械通气时间、并发症发生率、存活率、住院天数.结果 治疗组临床症状缓解快,用PS后1 h、6 h、12 h、24 h,OI降低而a/A PO2增高,差异有显著性（P＜0.01）;上机时间缩短,呼吸机各项指标均在短时间内下调,住院时间缩短（P＜0.01）,无一例发生并发症.结论 PS与机械通气联合治疗HMD能快速、有效改善患儿肺功能,降低呼吸机治疗条件,上机时间、住院时间缩短, 疗效好,操作容易;降低机械通气并发症的发生率,值得在基层医院推广.

Objective To evaluate the effectiveness of combination of pulmonary surfaetant and mechanical ventilation to treat new - born infants hyaline membrane disease treating newborn infant hyaline membrane disease （HMD）in subordinate hospitals. Methods Once the newborn infants were diagnosed as HMD,the group of newborn infants suffered from HMD were given PS two times within 12 hours being supported by ventilator. We alternated the routine method of PS given one intermission method within a short time （ the doses given were 150 - 200mg/kg and 100mg/kg rcspectively）. The primary evaluated parameters： the Oxygenation index（OI） at different time after giving PS, Alveolar/Arterial ratio of PCO2 （ a/A PO2 ） ,getting improved in clinical conditions;The secondary evaluated parameters： Duration of supported by Ventilator, rate of complications, survival rate and duration of hospitalization. Results The clinical condition of treating group got improved soon after giving the PS 1 h, 6 h, 12 h, 24 h with decreasing of OI and increasing of a/A PO2. All were with significant statistic difference（ P 〈0,001 ）. Shorten duration for being supported by ventilator and relevant parameters could be down - regulated in a short time and an average time of hospitalization without complications in any case, P 〈 0.01. Conclusion mechanical ventilation combined with PS can improve lung function of newborn infants with HMD quickly, can shorten the duration of using ventilator and hospitalization. It is effective and easy to be operated. It is benefit for reducing complications. So it is worthy to be widely promoted at subordinate hospitals.