肺表面活性物质治疗新生儿肺透明膜病的临床研究

A clinical trial of pulmonary surfactant replacement therapy in neonates with pulmonary hyaline membrane disease.

目的:探讨肺表面活性物质(PS)治疗肺透明膜病(HMD)的疗效及其临床应用价值。方法:观察30例HMD患儿给予Exsurf治疗前后肺氧合功能、机械通气参数及肺泡充气程度的变化。结果:应用PS后1/2 h、6 h、12 h、48 h及72 h患儿血PaO2、a/A PO2及pH值较用药前明显上升,而氧合指数(O I)、PaCO2值明显下降。各时间点PaO2、PaCO2、a/APO2、O I、pH与用药前比较,二者之间差异均有显著性意义(P<0.05或P<0.01)。机械通气参数F iO2、PIP、PEEP及MAP在用药后6 h逐渐降低,12 h开始显著下降,与用药前比较,差异均有显著性意义(P<0.05或P<0.01)。用药后12 h胸片提示肺部病变明显改善。用药后肺炎、颅内出血等并发症发生率分别为70.0%和36.7%。结论:PS能有效改善HMD患儿的肺氧合功能,降低机械通气参数。

Objective： To study the efficacy and clinical value of pulmonary surfactant （PS） in the replacement therapy for neonates with hyaline membrane disease （HMD）. Methods： 30 cases of neonates with HMD treated with Exosurf were observed the changes of patient＇s pulmonary function, mechanical ventilation parameters and the changing degree of air filling in pulmonary alveolus before and after replacement therapy. Results： The PaO2, a/A PO2 and pH in the patients with HMD were obviously increased, OI and PaCO2 obviously decreased at 1/2, 6, 2, 48 and 72 h after suffactant replacement therapy. In comparison with the subjects before and after suffactant replacement therapy, significant differences were found respectively （P 〈0.05 or P 〈 0.01）. Mechanical ventilation parameters, such as FiO2, PIP, PEEP and MAP were decreased at 6 h after treated with PS, and obviously decreased at 12h. In comparison with the subjects before and after surfactant replacement therapy, significant differences were found respectively （P 〈 0.05 or P 〈 0.01）. Pathological changes were improved evidently that it was identified by X - ray chest picture at 12 h after the treatment. Occurrences of complications of pneumonia and intracranial hemorrhage were respectively 70.0% and 36.7%. Conclusion： PS could improve effectively oxygenation in neonates with HMD and decrease the parameters of mechanical ventilation.