大剂量盐酸氨溴索联合鼻塞/鼻罩持续气道正压通气治疗新生儿呼吸窘迫综合征疗效评价

Curative Effect Evaluation of Ambroxol Combined with Nasal Continuous Positive Airway Pressure in the Treatment of Neonatal Respiratory Distress Syndrome

目的：评价大剂量氨溴索联合鼻影鼻罩持续气道正压通气（nCPAP）治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法：将49例NRDS患儿随机分为治疗组25例和对照组24例，均给予温箱保暖、预防感染、纠正酸中毒、持续胃肠减压、静脉营养、呼吸道护理及监测生命体征等综合管理。两组均给予nCPAP治疗：选用BubbleCPAPsystem，根据鼻部大小选择鼻塞及鼻罩，鼻塞和鼻罩交替使用，每4h更换1次，初始流量6—8L，吸入氧浓度（FiO：）0．40—0．60，压力5～8emH：O，以后酌情调整；当Fi02〈O．30、压力降至2emH20，而氧分压（Pa02）保持在60一90mmHg、二氧化碳分压（PaC02）〈50mtnHg、胸片明显好转时，改为头罩或鼻导管吸氧。治疗组入院即给予盐酸氨溴索30mg／（kg·d）每日分4次用微量泵静脉输注，每次输注时间〉5rain，连用5d。比较两组疗效及氧合指标变化。结果：（1）治疗组总有效率92．O％，对照组75．0％，两组比较差异无统计学意义（P〉O．05）；（2）治疗组nCPAP上机时间、用氧时间、住院时间短于对照组（P〈0．01）；（3）从治疗后24h开始，治疗组血气分析及氧合指标优于对照组（p〈0．05）。结论：大剂量盐酸氨溴索联合nCPAP治疗NRDS效果优于单用nCPAP治疗，值得基层医院推产应用。

Objective： To evaluate the clinical effect of Ambroxol Hydrochloride combined with nasal congestion/nasal mask continuous positive airway pressure （nCPAP） in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods： Forty-nine eases of NRDS were randomly divided into a treatment group with twenty-five cases （Ambroxol pals nCPAP） and a control group with twenty-four cases （nCPAP）. The same comprehensive treatment was given to the two groups. In the two groups were given nCPAP therapy with mercifully CPAP system, according to the size of the nose chosen stuffy nasal congestion and nasal mask, ahemate every 4 hours, initial flow was 6 ~ 8 L, FiO2 ： 0.40 - 0.60, pressure of 5 ~ 8 cm H2 O, adjust in appropriate time ; When FiO2 〈0.30, pressure drop to 2 cm H20, PaO2 ： 60 ~90 mm Hg, PaCO2〈50 mm Hg, chest radiograph improved markedly, alternate to the hood or nasal catheter oxygen. The treatment group were given ambroxol 30 mg/（kg ~ d） for five days additionally, four times a day with trace intravenous infusion pump, the infusion time 〉5 min each time. Compare the clinical efficacy of the two groups and the changes of oxygenation index and PaCO2. Results： （ 1 ） The total effectiveness of the treatment group and the control group were 92.0% vs 75.0% respectively, and there were no statistical significance （ P〉0.05 ）. （2） The length of ventilator support, oxygen supplyand hospital staywere significantly shorter than those of the control group （P〈0.01）. （3） The difference of oxygenation index and PaC02 in the two groups after 24 hours treatment had statistical significance （P〈0.05）. Conclusions： The effect of large dose ammonia bromine combined with line nCPAP in the treatment of NRDS is good and worthy of basic-level hospitals application.