CPAP通气支持下天然牛肺表面活性剂治疗新生儿肺透明膜病及对血气指标影响的研究

The research on dosage and timing of natural pulmonary surfactant in treating hyaline membrane disease under the support of continuous positive airway pressure

目的:探讨持续正压通气支持下天然牛肺表面活性剂(PS)治疗新生儿肺透明膜病(HMD)的用药剂量和时机。方法:选取95例HMD患儿给予外源性PS及经鼻持续气道正压通气治疗,对比不同治疗时间和出生体重的临床治疗效果以及血气指标改善情况。结果:PS治疗后HMD患儿的发绀、三凹征等呼吸困难症状和体征明显改善,且血气指标与治疗前比较有显著改善(t=36.383,t=16.362;P<0.05),无严重并发症发生。将给药时间分为<12 h和≥12 h,出生体重分为<1500 g和≥1500 g,不同给药时间PS总用量、PaO_2和Pa C恢复正常时间和住院天数均有统计学差异(t=10.853,t=5.761,t=8.374;P<0.05),不同出生体重患儿PS总用量无统计学差异(t=1.686,P>0.05),PaO_2、PaCO_2恢复正常时间和住院天数有统计学差异(t=4.697,t=8.215,P<0.05)。结论:PS联合CPAP作为临床治疗HMD安全有效的治疗手段,在改善患儿肺功能方面效果显著,治疗效果和给药时间、出生体重密切相关,外源性PS的使用量首要考虑的因素是给药时间。

Objective To explore dosage and timing of natural bovine pulmonary surfactant（PS） treating hyaline miembrane disease （HMD） under the support of continuous positive airway pressure（CPAP）. Methods： 95 HMD children were selected as the research object through exogenous PS and nasal CPAPtreatment, to compare the different treatment time and clinical therapeutic effect of birth weight, and improvementof blood gas index. Results： After treatment with cyanosis, three female character such as difficulty in breathingsigns and symptoms and blood gas index improved significantly （t=36.383, t=16.362; P〈0.05）, and no seriouscomplications occurred. Delivery time can be divided into 〈12 h and ≥12 h, and birth weight was divided into〈1500 g and ≥1500 g. The differences were statistically significant among PS total dosage of different dosing time,normal time of PaO2 and PaCO2 and hospitalization days （t=10.853, t=5.761, t=8.374; P〈0.05）. But there wereno statistical difference in different birth weight children with PS total amount （t=1.686, P〉0.05）. The differencesbetween normal time of PaO2 and PaCO2 and hospitalization days were statistically significant （t=4.697, t=8.215;P〈0.05）. Conclusion： PS joint CPAP as a means of treatment in the clinical treatment of HMD is safe andeffective to improve lung function. The treatment effect and the delivery time are closely related with birth weight.The delivery time is the first factors to considerate in the use of exogenous PS.