肺表面活性物质与盐酸氨溴索治疗新生儿肺透明膜病疗效比较

The efficacy comparison of pulmonary surfactant and ambroxol hydrochloride for treating neonatal hyaline membrane disease

目的观察肺表面活性物质与盐酸氨溴索治疗新生儿肺透明膜病的疗效。方法选择2013年7月—2015年4月宝鸡市人民医院新生儿科收治的新生儿肺透明膜病患儿66例,依据随机数字表法分为观察组与对照组,每组33例。观察组采取肺表面活性物质,对照组采取盐酸氨溴索治疗。比较2组患儿治疗效果、治疗前后血气指标与机械通气参数变化,观察2组息儿所需的给氧时间、持续气道正压通气（CPAP）时间、住院时间及住院费用。结果观察组患儿总有效率87.88%（29/33）明显高于对照组63.64%（21/33）,差异具有统计学意义（χ^2值=5.280,P〈0.05）。观察组患儿治疗3 d后的动脉二氧化碳分压（PaCO2）低于对照组[（4.02±1.01）kPa vs.（6.05±1.28）kPa],氧合指数（PaO2/FiO2）、动脉氧分压（PaO2）、pH值高于对照组[（455.24±25.21）mmHg、（12.03±3.13）kPa、（8.97±1.21）vs.（406.02±27.18）mmHg、（9.07±1.36）kPa、（8.01±1.22）],差异具有统计学意义（t=7.152、7.627、4.983、6.553,P〈0.05）。治疗3 d后,观察组患儿机械通气频率（F）、呼气末正压（PEEP）、气道峰压（PIP）、平均气道压（MAP）、吸入氧浓度（FiO2）指标明显比对照组低[（36±7）次/min、（3.21±0.55）cmH2O、（16.98±3.01）cmH2O、（7.98±2.01）cmH2O、（0.37±0.04）%vs.（40±8）次/min、（3.82±0.76）cmH2O、（19.04±3.62）cmH2O、（9.87±2.88）cmH2O、（0.48±0.11）%],差异具有统计学意义（t=3.735、2.162、2.514、3.135、5.399,P〈0.05）。观察组患儿的给氧时间、CPAP时间、住院时间明显短于对照组[（12.23±2.41）d vs.（15.31±2.37）d,（4.02±1.03）d vs.（6.06±1.31）d,（18.45±4.81）d vs.（24.11±6.61）d],但观察组患儿所需的治疗费用（3.14±0.27）万元明显比对照组（2.60±0.21）万元高,差异具有统计学意义明显差异（t=5.235、7.032、3.977、8.948,P〈0.05）。结论治疗新生儿肺透明膜病采取肺表面活性物质有着良好的疗效,但盐酸氨溴索治疗费用相对较低,能在一定程度上缓解患儿经济负担,从经济实惠角度出发,可作为治疗新生儿肺透明膜病的辅助性药物。

Objective To study the effect of pulmonary surfactant and ambroxol hydrochloride on the treatment of hyaline membrane disease.Methods 66 children with hyaline membrane disease in Neonatal Department,the Peoples Hospital of Baoji City from July 2013 to April 2015.They were divided randomly into observation group and control group,33 patients for each group.The observation group was treated with pulmonary surfactant,and the control group was treated with ambroxol hydrochloride.The therapeutic effect,and the changes of blood gas index and mechanical ventilation parameters before and after treatment in two groups were compared.Required oxygen time,continuous positive airway pressure（CPAP） time,hospital stay,and hospital costs were observed in both groups.Results The total effective rate of children in the observation group was87.88%（29/33）,significantly higher than 63.64%（21/33） in the control group,and that＇s a statistically significant difference（t =5.280,P〈0.05）.The arterial partial pressure of carbon dioxide（PaCO2） after treatment for 3days in the observation group was lower than the control group[（4.02±1.01） kPa vs.（6.05 ± 1.28） kPa],and oxygenation index（PaO2/FiO2）,arterial oxygen partial pressure（PaO2）,pH value was higher than the control group[（455.24 ± 25.21） mmHg,（12.03 ±3.13） kPa,（9.97±1.21） vs.（406.02 ±27.18）mmHg,（9.07 ±1.36） kPa,（8.01 ± 1.22）],and those were statistically significant differences（t =7.152,t =7.627,t =4.983,t =6.553,P〈0.05）.Positive end-expiratory pressure（PEEP）,mechanical ventilation frequency（F）,airway peak pressure（PIP）,mean airway pressure（MAP） and inhaled oxygen concentration（FiO2） index were obviously lower than the control group[（36 ±7） times/min,（3.21 ±0.55）cmH2O,（16.98±3.01） cmH2O,（7.98 ± 2.01） cmH2O,（0.37 ±0.04）%vs.（40 ± 8） times/min,（3.82 ±0.76）cmH2O,（19.04±3.62） cmH2O,（9.87±2.88） cmH2O,（0.48 ±0.11）%],that＇s a statistically significant difference（t = 3.735,t =2.162,t =2.514,t =3.135,t =5.399,P〈0.05）.Given oxygen time,CPAP time,hospitalization time significantly shorter than the control group[（12.23 ±2.41）d vs.（15.31 ±2.37）d,（4.02 ± 1.03）d vs.（6.06 ± 1.31）d,（18.45 ±4.81）d vs.（24.11 ±6.61）d],but the cost of treatment of children in observation group of（3.14 ±0.27）×10^4 yuan was significantly higher than control group of（2.60 ±0.21）×10^4 yuan,and those were statistically significant differences（t =5.235,t =7.032,t =3.977,t =8.948,P〈0.05）.Conclusion There is a good curative effect of taking a lung surface active material on treating neonatal pulmonary hyaline membrane disease,but the treatment cost of ambroxol hydrochloride is relatively low,to a certain extent,it can ease the financial burden of patients,and from the perspective of economic and practical,it can be used as adjuvant drugs for the treatment of neonatal pulmonary hyaline membrane disease.