高频振荡通气联合牛肺表面活性剂在治疗新生儿胎粪吸入综合征中的应用

Application of high frequency oscillation ventilation in combination with calf pulmonary surfactant for injection in the treatment of neonatal meconium aspiration syndrome

目的了解高频振荡通气联合珂立苏(牛肺表面活性剂)在治疗新生儿胎粪吸入综合征(MAS)中的应用。方法将2012年5月至2015年7月收治的84例MAS患儿分为实验组(50例)和对照组(34例),实验组采用高频振荡通气联合珂立苏治疗,对照组采用同步间歇指令通气。测定两组患儿治疗前后的血气分析指标、使用呼吸机时间、氧疗时间、住院时间、并发症和病死率。结果治疗后,两组患儿的吸氧浓度、氧合指数、肺动脉氧分压差、二氧分碳分压、吸入氧体积分数均有明显改善,以实验组改善更加显著(P<0.05);与对照组相比,实验组使用呼吸机时间和氧疗时间更短(P<0.01),呼吸机相关性肺炎的发生率更低(P<0.05)。实验组与对照组病死率分别为(8.0%vs 11.7%,P>0.05)。结论高频振荡通气联合珂立苏治疗新生儿MAS效果显著,减少患儿使用呼吸机时间和氧疗时间,降低呼吸机相关性肺炎的发生率。

Objective To investigate the application of high frequency oscillation ventilation in combination with Ke Li Su（calf pulmonary surfactant for injection） in the treatment of neonatal meconium aspiration syndrome（MAS）. Methods 84 sick children with MAS patients receive and cured from May 2012 to July 2015 were divided into Experimental Group（50 cases） and Control Group（34 cases）. Experimental Group received treatment with high frequency oscillation ventilation in combination with Ke Li Su,and Control Group received treatment with synchronized intermittent mandatory ventilation. Blood gas analysis,the application time of breathing machine,the time for oxygen therapy,hospital stay,complication and death rate of the two groups before and after treatment were measured. Results The FiO2,OI,PaO2,PCO2 and fraction of inspired oxygen of the both groups were all significantly improved,and Experiment Group had a more significant improvement（P〈0.05）. Compared with Control Group,Experiment Group had a much shorter application time of breathing machine and time for oxygen therapy was shorter（P〈0.01）,and had a lower incidence of ventilator-associated pneumonia（P〈0.05）. Conclusion The high frequency oscillation ventilation in combination with Ke Li Su has a significant effect on neonatal MAS. It can significantly reduce the application time of breathing machine and the time for oxygen therapy and reduce the incidence of ventilator-associated pneumonia.