外源性肺表面活性物质治疗新生儿急性肺损伤25例

Clinical Effects of Exogenous Pulmonary Surfactant in Treatment of Newborns with Acute Lung Injury

目的观察外源性肺表面活性物质(PS)治疗新生儿急性肺损伤(ALI)的效果。方法 ALI患儿25例,在常规机械通气的基础上,经气管插管气管内滴入PS 100 mg.kg-1,观察患儿上机前、上机后使用PS前、使用PS后2,6,24,48 h拔管前的血气参数,比较动脉氧分压/肺泡氧分压(PaO2/FiO2)。结果使用PS后,患儿2,6,24 h氧分压分别为(14.02±2.29),(12.29±2.22),(11.42±1.89)kPa,与基础值比较差异有统计学意义(P<0.05);PaO2/FiO2值增高(P<0.05);48 h后氧分压有下降趋势,但没有降到使用PS前的水平(P<0.05)。结论气管内滴入PS对新生儿ALI可明显改善氧合,降低呼吸机的参数,改善预后。

Objective To investigate the effects of exogenous pulmonary surfactant （PS） supplementation in treating newborns with acute lung injury. Methods A prospective physiologic study was conducted in the neonatal intensive care unit （NICU） , 25 neonates with acute lung injury were enrolled from January 2006 to June 2008. All patients received mechanical ventilating （MV） and exogenous pulmonary surfactant （100 mg·kg-t） by tracheal instillation. Blood gas and oxygenation index （PaOi/FiO2 ） were analyzed at different time points during the treatment process, including pre-MV, post-MV, before and ＇after given PS （2, 6, 24, and 48 h after PS treatment, pre-decannulation）. Results At different time points （2, 6, and 24 h ＇after PS treatment）, the arterial partial pressure of oxygen was （14.02±2.29） , （12.29±2.22） and （ 11.42± 1.89） kPa. Both PaO2 and respiratory index （PaOz/FiO2 ） were significantly improved as compared with baseline （P 〈 0. 05 ）, PaO2 and respiratory index showed a descending trend 48 h after PS treatment, with significant difference as compared with baseline （ P〈 0.05）. Conclusion The intratracheal instillation of exogenous PS in neonates with acute lung injury was effective. It can improve oxygenation rapidly, improve prognosis, and reduce the parameters of MV.