机械通气联合不同途径止血药物对新生儿肺出血肺部状态及临床表现的影响

Effects of mechanical ventilation combined with different ways of hemostasia drugs on pulmonary status and clinical manifestations in neonates with pulmonary hemorrhage

目的:探讨两种止血药物用药途径与机械通气联合治疗新生儿肺出血的临床效果。方法:回顾性分析2015-01—2018-06期间86例新生儿肺出血患儿资料,根据不同治疗方法分组,对照组43例,行机械通气联合白眉蛇毒血凝酶静脉推注;观察组43例,行机械通气联合白眉蛇毒血凝酶静脉推注与气管内滴入,观察两组肺部状态与临床表现,血气分析指标与氧合指数变化,并发症发生率及病死率。结果:观察组肺部出血停止时间、体温恢复时间、肤色恢复时间及住院时间明显比对照组短,差异有统计学意义(P <0.05);治疗前两组血氧分压(PaO2)、氧合指数(OI)、二氧化碳分压(PaCO2)水平差异无统计学意义(P>0.05),治疗后均有改善,观察组治疗24h后PaO2、OI、PaCO2与同期对照组相比,差异有统计学意义(P<0.05);观察组并发症发生率、病死率分别为16.28%、11.63%,与对照组的37.21%、30.23%比较,差异有统计学意义(P<0.05)。结论:机械通气联合止血药物静脉推注与气管内滴入途径给药,可缩短止血时间,改善肺部状态及临床症状,降低患儿并发症发生率及死亡率,值得推广。

Objective:To explore the clinical effect of two kinds of hemostasia drugs combined with mechanical ventilation in the treatment of neonates with pulmonary hemorrhage.Method:The data of 86 neonates with pulmonary hemorrhage from January 2015 to June 2018 were retrospectively analyzed and according to different treatment methods,the patients were divided into two groups.43 neonates in the control group were treated with mechanical ventilation combined with intravenous injection of hemagglutinin from trachea venom while 43 neonates in the observation group were treated with mechanical ventilation combined with intravenous injection of hemagglutinin from trachea venom and intratracheal instillation.The pulmonary status and clinical manifestations,indexes of blood gas analysis and changes of oxygenation index,complication rate and mortality were observed.Result:The time of pulmonary hemorrhage stopping,body temperature recovery,skin color recovery and the time of stay in hospital in observation group were significantly shorter than those in control group,and the difference was statistically significant(P<0.05).There was no significant difference in the levels of PaO2,OI and PaCO2 between the two groups before treatment(P>0.05),but after 24 hours of treatment,the levels of PaO2,OI and PaCO2 in the observation group were significantly different from those in the control group(P<0.05).The incidence of complications and mortality in the observation group were respectively 16.28%and 11.63%,and compared with 37.21%and 30.23%in the control group,the difference was statistically significant(P<0.05).Conclusion:Mechanical ventilation combined with intravenous infusion of hemostatic drugs and intratracheal instillation can shorten the bleeding time,improve the lung condition and clinical symptoms and can also reduce the incidence of complications and mortality in children,which is worthy of promotion.