维生素A联合牛肺表面活性物质治疗新生儿呼吸窘迫综合征的临床研究

Clinical study on vitamin A combined with calf pulmonary surfactant in treatment of neonatal respiratory distress syndrome

目的探讨维生素A软胶囊联合注射用牛肺表面活性剂治疗新生儿呼吸窘迫综合征的临床疗效。方法选取2013年11月—2015年11月重庆市合川区妇幼保健计划生育服务中心收治的新生儿呼吸窘迫综合征患儿80例,采用随机数字表法将患儿分为对照组和治疗组,每组各40例。对照组气管内给予注射用牛肺表面活性剂,首剂量40～100 mg/kg,根据病情需要6～24 h重复用药,最多3次,72 h后不再给药。治疗组在对照组基础上口服维生素A软胶囊4 500 U/d,以配方奶为载体,每天11：00～12：00一次性给予。两组患儿均连续治疗7 d。观察两组的临床疗效,同时比较两组治疗前后血气指标、机械通气参数、氧化应激指标。结果治疗后,对照组、治疗组的总有效率分别为72.6%、90.0%,两组总有效率比较差异具有统计学意义（P〈0.05）。治疗后,两组二氧化碳分压（Pa CO2）、呼吸频率（RR）、呼气末正压（PEEP）、吸入气中氧浓度分数（Fi O2）、丙二醛（MDA）均显著降低,氧分压（Pa O2）、p H值、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）,均显著升高,同组治疗前后差异具有统计学意义（P〈0.05）;且治疗组这些指标的改善程度优于对照组,两组比较差异具有统计学意义（P〈0.05）。结论维生素A软胶囊联合注射用牛肺表面活性剂治疗新生儿呼吸窘迫综合征具有较好的临床疗效,能够改善肺功能,减轻机体抗氧化能力,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Vitamin A Soft Capsules combined with Calf Pulmonary Surfactant for injection in treatment of neonatal respiratory distress syndrome. Methods Children（80 cases） with neonatal respiratory distress syndrome in the Chongqing Hechuan District Maternal and Child Health Care Family Planning Service Center from November 2013 to November 2015 were divided into the control and treatment groups according to the random number table, and each group had 40 cases. Chidren in the control group were given Calf Pulmonary Surfactant for injection through trachea, and the initial dose was 40 — 100 mg/kg. According to the needs of condition, the drugs were repeatedly given in 6 — 24 h, up to 3 times, and there was no medication after 72 h. Children in the treatment group were po administered with Vitamin A Soft Capsules on the basis of the control group 4 500 U/d at 11：00 — 12：00, with formula milk as the carrier, once daily. Children in two groups were treated for 7 d. After treatment, the clinical curative effects in the two groups were evaluated, and blood gas indexes, mechanical ventilation indexes, and oxidative stress indexes were compared before and after treatment. Results After treatment, the efficacies in the control and treatment groups were 72.6% and 90.0%, respectively, and there was difference between two groups（P〈0.05）. After treatment, partial pressure of carbon dioxide（Pa CO2）, respiratory rate（RR）, positive end expiratory pressure（PEEP）, fraction of inspiration oxygen（Fi O2）, and malondialdehyde（MDA） were significantly decreased, while oxygen partial pressure（Pa O2）, p H value, superoxide dismutase（SOD） and glutathione peroxidase（GSH-Px） in the two groups were significantly increased, and the differences were statistically significant in the same group（P〈0.05）. After treatment, the observational indexes were significantly better than those in the control group, with significant difference between two groups（P〈0.05）. Conclusion Vitamin A Soft Capsules combined with Calf Pulmonary Surfactant for injection has good clinical efficacy in treatment of neonatal respiratory distress syndrome, can improve lung function, reduce the body＇s antioxidant capacity, which has a certain clinical application value.