产前盐酸氨溴索对肺表面活性物质防治新生儿呼吸窘迫综合征的辅助作用

The accessorial effect of antenatal ambroxol hydrochloride on neonatal respiratory distress syndrome before postpartum postpartum pulmonary surfactant therapy

目的:研究在产前预防应用盐酸氨溴索(沐舒坦)联合糖皮质激素对产后应用肺表面活性物质(PS)预防新生儿呼吸窘迫综合征(NRDS)的辅助作用。方法:将胎龄不满35周并在生后1 h内经气管内给予PS预防NRDS的早产患儿按产前情况分为3组:由于各种原因未能采取预防措施组,产前常规应用地塞米松预防组,产前应用大剂量沐舒坦联合地塞米松预防组。比较3组NRDS的发生率、机械辅助通气时间及24 h内动态血气分析。结果:3组NRDS的发生率无显著差异,地塞米松联合沐舒坦组机械通气时间明显低于未预防组。单纯地塞米松预防组与未预防组动脉血气在应用PS后恢复速度慢于联合沐舒坦组,特别是前两组血气PaO2在应用PS 6 h后出现下降,而联合沐舒坦预防组PaO2恢复后变化平稳。结论:联合沐舒坦预防组6 h后各项血气指标即达到相对稳定,说明产前地塞米松联合沐舒坦辅助生后PS预防NRDS可以缩短单纯应用PS患儿动脉血气达到相对正常值的过程,从而缩短机械通气时间。

Objective： To study the accessorial effect of antenatal ambroxol hydrochlofide on neonatal respiratory distress syndrome （NRDS） before postpartum postpartum pulmonary surfactant （PS） therapy. Methods： 35 premature infants were divided into three groups according to different antepartum prophylactic treatments： dexamethasone combined with ambroxol hydrochloride prophylactic therapy group, simple dexamethasone prophylactic therapy group and no prophylactic treatment group, all patients received PS in 1 hour after birth. The incidence of NRDS, arterial blood gas in 24 hours and the time of mechanical ventilation in three groups were compared. Results ： There was no significant difference in the incidence of NRDS between three groups. The time of mechanical ventilation of dexamethasone combined with ambroxol hydrochloride group was significantly lower than that of no prophylactic treatment group. The time of convalescence after PS therapy in simple dexamethasone group and no prophylactic treatment group were slower than that in dexamethasone combined with ambroxol hydrochloride group, especially PaO2 , there was a sudden fall after PS treatment for 6 hours in former two groups, however, dexamethasone combined with ambroxol hydrochloride group showed a steady fluctuation. Conclusion： Compared with simple PS therapy, antepartum high dose ambroxol hydrochloride combined with glucocorticoid which are combined with postpartum therapy can slower the time course that arterial blood gas recover to normal, and shorten the time of mechanical ventilation.