重复使用肺表面活性物质治疗新生儿重症胎粪吸入综合征的临床研究

Repeated administration of surfactant therapy in newborn infants with meconium aspiration syndrome

目的评估和验证重复使用肺表面活性物质(PS)治疗新生儿胎粪吸入综合征(MAS)的临床疗效。方法选择50例MAS患儿均给予机械通气,并采用PS治疗。使用首剂药物Curosurf 100mg/kg,间隔12h后再使用第2剂PS。结果第1剂PS治疗后12h患儿动脉血氧分压(PaO_2)、动脉血氧分压与吸入氧浓度比值(PaO_2/FiO_2)、动脉肺泡血氧分压比值(a/APO_2)虽高于用药前,但与之比较差异无统计学意义(P>0.05)。应用第2剂PS后,患儿PaO_2、PaO_2/FiO_2、a/APO_2均显著升高,差异有统计学意义(P<0.01);且呼吸机参数吸入氧浓度(FiO_2)、峰压(PIP)、平均气道压(MAP)、呼吸频率(RR)明显降低,用药12h后以上参数与第1剂PS用药12h后比较,差异有统计学意义(P<0.05)。结论重复使用PS能更有效并持续改善MAS患儿肺顺应性及氧合功能。

Objective To evaluate and validate the efficacy of repeated surfactant therapy in newborn infants with meconium aspiration syndrome（MAS）.Methods Fifty neonates with MAS were treated with mechanical ventilation and pulmonary surfactant.The first dose was given with drug Curosurf（Italy）100mg/kg,after 12 hours the second dose was been used.Results Twelve hours after administration of the first dose of surfactant,the values for arterial partial pressure oxygen（PaO2）,PaO2/fraction of inspired oxygen（FiO2）ratio,arterial oxygen/alveolar oxygen ratio（a/APO2）of those patients were higher than those before treatment although,but there were no significant differences（P〉0.05）.After receiving a second dose of surfactant,PaO2,PaO2/FiO2,a/APO2 of those patients significantly increased,and after twelve hours above parameters were significant differences compared with those parameters receiving the first dose of surfactant twelve hours（P〈0.01）,and FiO2,PIP,MAP,RR significantly decreased,and after twelve hours above parameters were significant differences compared with those parameters receiving the first dose of surfactant twelve hours（P〈0.05）.Conclusion Repeated use PS can improve the MAS children with pulmonary compliance and oxygenation function more effectively and continuously.