盐酸氨溴索呼吸道冲洗对机械通气早产儿呼吸力学的影响

Effect of Washing Respiratory Way with Ambroxol Hydrochloride on Respiratory Mechanics in Premature Infant with Ventilation

目的观察机械通气时用盐酸氨溴索(AM)呼吸道冲洗治疗新生儿呼吸窘迫综合征(NRDS)的效果,探讨AM呼吸道冲洗后呼吸力学的动态变化。方法选取符合NRDS诊断标准的30例早产儿。随机分为9 g/L盐水(NS)组和AM组各15例。二组均应用Babylog8000呼吸机,常规治疗和护理,NS组给予9 g/L盐水行呼吸道冲洗,AM组则应用AM冲洗液行呼吸道冲洗。观察二组肺顺应性(C)、时间常数(Tc)、呼吸道阻力(R)、肺过度膨胀系数(C20/C)、分钟通气量(MV)。上机后1 h检查血气,24 h摄胸部X线片。结果AM组上机时C为(2.72±0.91)mL/kPa,脱机时为(6.01±1.22)mL/kPa,二者比较差异显著(P<0.05)。上机治疗24 h后,AM组较NS组患儿C明显改善,分别为(5.83±1.12)mL/kPa和(4.51±1.21)mL/kPa(P<0.05);AM组较NS组Tc明显增加,分别为(36.0±12.0)s和(24.0±11.0)s(P<0.05);AM组R为(6.21±0.81)kPa/(L.s),NS组为(6.02±0.84)kPa/(L.s),二组无显著差异(P>0.05);二组C20/C均无明显变化(Pa>0.05);AM组MV为(0.56±0.12)L/min,NS组MV为(0.35±0.11)L/min,二组差异显著(P<0.05)。二组血气变化无显著差异,上机1 h后AM和NS组pa(O2)分别为(8.28±0.97)kPa和(7.99±0.85)kPa(P>0.05)。AM较NS组平均上机时间明显缩短,分别为(60.52±6.23)h和(98.21±5.82)h(P<0.05)。结论AM呼吸道冲洗能较好治疗NRDS,增加C,改善肺泡通气,改善肺氧合,缩短上机时间。

Objective To observe the effect of using Ambroxol hydrochloride（AM） to wash respiratory way to treat neonatal respiratory distress syndrome（NRDS） in ventilator,to explore dynamic changes of respiratory mechanics after using AM to wash respiratory way. Methods Thirty premature infants were chosen according with diagnosis criterion, which were randomly divided into 2 groups- NS group（ n = 15 ） ;AM group（ n = 15 ）. Both NS and AM groups were treated with Babylog 8 000 ventilator, and routine treating and nursing, NS group was given for washing respiratory way in NS group, whereas AM was done in AM group. Pulmonary compliance （C）, time constant （Tc）, respiratory resistance（ R）, C20/C and minute volume （MV）were observed in both groups. Blood gas was routinely checked after 1 h ventilation treatment, and X ray was shot after 24 h. Results Pulmonary C significantly increased in weaning than that of beginning ventilation （P 〈 0.05 ）. When compared with NS group after 24 h continuous treating, pulmonary C significantly improved in group AM, respectively （5.83 ± 1.12 ） mL/kPa and（4.51 ± 1.21 ） mL/kPa（P 〈0.05 ） ;Tc increased markedly in group AM than that of group NS,respectively[ （36.0 ± 12.0） s vs （24.0 ±11.0） s（P 〈 0.05 ） ] ; there were no differences in respiratory R and C20/C between 2 groups （ Pa 〉 0.05 ） , MV significantly increased in group AM than NS, respectively [ （0.56 ±0. 12 ） L/min and （ 0.35 ± 0. 11 ） L/min （ P 〈 0.05 ） ]. There were no differences in blood gas between group AM and NS after 1 h ventilation treating（ P 〉 0.05 ）. But ventilator -treating -time was markedly shorter in group AM than NS, respectively（60.52 ± 6.23 ） h and（98.21 ± 5.82） h（P 〈 0.05）. Conclusion It can preferably treat NRDS to use AM washing respiratory way,increasing pulmonary C, improving alveolus aerating and lung oxygenation, shortening time of ventilator treating.