布地奈德混悬液联合盐酸氨溴索氧气驱动雾化吸入防治新生儿胎粪吸入综合征

Budesonide suspension associated with ambroxol hydrochloride to treat meconium aspiration syndrome of newborn by atomizing inhalation with oxygen-driven

目的观察布地奈德混悬液联合盐酸氨溴索氧气驱动雾化吸入治疗新生儿胎粪吸入综合征（MAS）的临床疗效。方法56例MAS患儿分为对照组（26例）和观察组（30例）。2组均给予常规综合治疗，在此基础上，观察组应用布地奈德混悬液（每次0．25mg）＋盐酸氨溴索（每次10mg·kg^-1）氧气驱动雾化吸入；对照组应用盐酸氨溴索针（每次10mg·kg^-1）静脉注射。2组均8h1次，连用5～7d。观察2组用药后24、48、72h动脉血氧和指数（动脉血氧分压／吸入氧浓度，PaO2／FiO2）、动脉血二氧化碳分压（PaCO2）的变化以及需要机械通气比例、出现并发症比例、氧疗及住院时间、病死率等。结果用药后24hPaO2／FiO2、PaCO2水平观察组比对照组有改善趋势，但差别无统计学意义（P〉0．05）；用药后48、72h观察组PaO2／FiO2较对照组增高，PaCO2较对照组降低，差别均有统计学意义（P〈0．05）。观察组机械通气比例、并发症发生率、氧疗和住院时间及病死率均低于对照组，差别均有统计学意义（P〈0．05）。结论布地奈德混悬液联合盐酸氨溴索氧气驱动雾化吸入能改善MAS新生儿通换气功能，减少患儿机械通气的机会和新生儿呼吸窘迫综合征等并发症的发生，缩短氧疗时间和住院时间，降低病死率。

Objective To observe the clinical efficacy of budesonide suspension associated with ambroxol hydrochloride to treat meconium aspiration syndrome （MAS） of newborn by atomizing inhalation with oxygen-driven. Methods Fifty-six MAS neonatal patients were divided into control group （ n = 26 ） and observation group （ n = 30 ）. The two groups were given routine combined modality therapy. Based on this, patients in observation group were given budesonide 0.25 mg each time and ambroxol hydrochloride 10 mg . kg^-1 each time by atomizing inhalation with oxygen-driven, once in every eight hours and for 5 -7 days. The control group was only given ambroxol hydrochloride 10 mg . kg^-1 each time via intravenous injection, once in every eight hours and for 5 -7 days. Arterial oxygen and index（ arterial partial pressure of oxygen/fraction of inspired oxygen, PaO2/FiO2 ） , arterial carbon dioxide partial pressure（ PaCO2 ） level, ratio of mechanical ventilation and complications, time of oxygen therapy and hospitalization and fatality rate in the two groups were observed and compared at 24,48 and 72 hours after the treatment. Results PaO2/FiO2 and PaCO2 levels were significantly improved in the observation group compared to the control group after treatment for 24 hours, but the difference was not statistically significant（ P 〉 0. 05 ）. After treatment for 48 and 72 hours, PaO2/ FiO2 in observation group was higher than that in control group ,but PaCO2 was lower than control group（ P 〈 0.05 ）. In observation group the ratio of mechanical ventilation and complications, the time of oxygen therapy and hospitalization and fatality rate were lower than that in control group,there was statistically significant differences （P 〈 0.05 ）. Conclusion Budesonide suspension combined with ambroxol hydrochlorlde atomizing inhalation with oxygen-driven can significantly improve MAS neonates＇ ventilation function, reduce the ratio of mechanical ventilation and the incidence of NRDS and other complications, shorten the time of oxygen therapy and hospitalization, and reduce the mortality.