肺表面活性物质治疗足月新生儿肺出血的临床研究

Clinical application of pulmonary surfactants to full term infants with pulmonary hemorrhage

目的:观察外源性肺表面活性物质(pulmonary surfactant,PS)在足月新生儿肺出血治疗中的安全性和疗效。方法:40例肺出血足月新生儿,随机分为PS组(机械通气+气管内滴注血凝酶和PS)和对照组(机械通气+气管内滴注血凝酶),每组20例,两组患儿用药后6、12、24h分别桡动脉采集血样行血气分析,同时记录呼吸机的相关参数[呼吸力学指标:吸气峰压(PIP)和呼吸系统顺应性(Crs);患儿的病死率、肺出血停止平均时间和撤离呼吸机时间。结果:PS组治愈18例,死亡2例,对照组治愈17例,死亡3例,两组病死率(10%vs 15%)比较差异无统计学意义(P>0.05);PS组患儿肺出血停止时间和撤离呼吸机时间较对照组明显缩短,差异均有统计学意义(P均<0.05);PS组各时间点呼吸力学指标PIP均低于对照组,而Crs均高于对照组,差异均有统计学意义(P均<0.05);PS组各时间点氧动力学指标动脉血氧分压(PaO2)和氧合指数(PaO2/FiO2)均高于对照组,差异均有统计学意义(P均<0.05),两组动脉血二氧化碳分压(PaCO2)在各时间点比较差异无统计学意义(P均>0.05)。结论:外源性PS在足月新生儿肺出血的治疗中是安全、有效的。

AIM： To evaluate the efficacy and safety of the exogenous pulmonary surfactants （PS） in the treatment of full term neonates with pulmonary hemorrhage. METHODS： Forty full- term newborns with pulmonary hemorrhage were equally randomized into PS group （mechan- ical ventilation q-PS and instillation of hemo- eoagulase via endotracheal tube,n=20） and con- trol group（mechanical ventilation ＋ hemocoagu- lase instillation via endotracheal tube, n= 20）. The blood was obtained in the two groups via ra- dial artery respectively at 6 , 12 ,24 h after in- tervention for blood gas analysis. Other data were maintained concerning the indexes of re- spiratory mechanics（PIP and Crs）, oxygen ki- netic（PaCO2 ,PaO2 and PaOz/FiO2）, case fatali- ty rate, mean time for stoppage of pulmonary hemorrhage and withdrawal of the breathing ap- paratus. RESULTS. In PS group, 18 cases were cured and 2 cases died, and in the controls, 17cases were cured and death occurred in 3 cases. The case fatality rate was 10% vs 15% for the two groups, there was no statistically significant difference （P〉0.05）. The time for hemorrhage stoppage and withdrawal of the ventilator was significantly reduced in PS group, and the inde- xes of PIP at each time point were lower, where- as the levels of Crs, PaO2 and PaO2/FiO2 were elevated; compared with the controls, there were statistically significant difference （ all P 〈0.05）, while there was no statistically signifi- cant difference about the PaO2 at each point （all P〈 0.05） had no difference. CONCLUSION： The exogenous PS is safe and effective in treat- ment of full-term neonates with pulmonary hem-orrhage.