肺表面活性物质联合机械通气治疗新生儿肺出血疗效观察

Observation on the effect of combined treatment of lung surface active substance with mechanical ventilation for neonatal pulmonary hemorrhage

目的观察肺表面活性物质联合机械通气治疗新生儿肺出血的临床疗效。方法 2012年1月至2015年10月深圳市龙华新区人民医院新生儿科收治新生儿肺出血患儿102例,随机分为对照组和观察组各51例。两组患儿均给予气管插管,呼吸机辅助呼吸。对照组气管内注入血凝酶、肾上腺素;观察组气管内注入血凝酶、猪肺磷脂注射液。观察两组患儿治疗后6、12、24、48h肺出血面积、肺出血持续时间、机械通气时间、不良反应及临床疗效。结果两组治疗后12、24、48h与治疗前肺出血面积相比较,差异有统计学意义(P<0.05)。观察组治疗后12、24、48h肺出血面积显著低于对照组,差异有统计学意义(P<0.05)。观察组患儿肺出血持续时间、机械通气时间比对照组明显缩短,差异有统计学意义(P<0.05)。观察组治愈率为84.31%(43/51),显著高于对照组66.67%(34/51),差异有统计学意义(P<0.05)。两组患儿均未发生明显不良反应。结论机械通气联合肺表面活性物质可以显著减少肺出血面积,缩短肺出血持续时间和机械通气时间,提高治愈率,值得在临床大力推广应用。

Objective To study the effect of combined treatment of lung surface active substance with mechanical ventilation for neonatal pulmonary hemorrhage.Methods Totally 102 neonates with neonatal pulmonary hemorrhage were randomly assigned into the control group（51cases,given endotracheal injection of blood clotting enzyme and epinephrine）and the observation group（51cases,given endotracheal injection of blood clotting enzyme and lung surface active substance）.Pulmonary bleeding areas,pulmonary hemorrhage duration,mechanical ventilation duration,and adverse reactions were observed respectively at 6hours,12 hours,24hours,and 48 hours after treatment.Results Twelve hours,24 hours,and 48 hours after treatment,the difference of pulmonary hemorrhage areas in the two groups were statistically significant compared with that before treatment in both groups（P〈0.05）.The pulmonary hemorrhage areas of the observation group at 12 hours,24hours,and 48 hours after treatment were much smaller than the control group,the difference being statistically significant（P〈0.05）.Pulmonary hemorrhage duration and mechanical ventilation duration were significantly shorter than the control group（P〈0.05）.The cure rate of the observation group（84.31%,43/51）was significantly higher than that of control group（66.67%,34/51）（P〈0.05）.There were no obvious adverse reactions in the two groups.Conclusion The combined treatment of mechanical ventilation with lung surface active substances can significantly reduce the lung bleeding areas,shorten the duration of pulmonary hemorrhage and mechanical ventilation,and improve the cure rate.