晚期新生儿呼吸窘迫综合征珂立苏应用剂量的研究

Study of Calsurf application dose for late neonatal respiratory distress syndrome

目的探讨珂立苏应用剂量对晚期新生儿呼吸窘迫综合征的影响。方法选取2014年7月-2015年12月青海省妇女儿童医院收治的新生儿呼吸窘迫综合征患儿95例,依据随机数表法分为大剂量组和小剂量组,比较用药前、用药后1、6、12及24 h两组患儿血氧分压(PaO_2)、动脉血二氧化碳分压(Pa CO2)、肺泡动脉氧分压差[P(A-a)O2]、吸入氧体积分数(FiO)2、氧合指数(OI)、X线评分及相关指标。结果大剂量组48例,治愈25例,好转21例,无效2例,总有效率为95.83%;小剂量组47例,治愈20例,好转19例,无效6例,死亡2例,总有效率为82.98%。用药前,两组患儿的PaO_2、PaCO_2、P(A-a)O_2、FiO_2、OI、X线评分差异无统计学意义(P>0.05)。大剂量组患儿在用药后1 h PaO_2迅速恢复,且在用药后6、12及24 h持续上升。小剂量组患儿PaO_2亦有所升高,但用药后1 h变化幅度并不明显,用药后24 h PaO_2水平仍低于大剂量组。给药后1 h内,两组患儿的PaCO_2均有所下降,但变化并不明显,至用药后6 h,患儿PaCO_2较用药前降低,且在用药后12和24 h内维持稳定状态。给药后1 h,大剂量组患儿P(A-a)O_2降至200 mm Hg左右,小剂量组患儿的平均P(A-aO_2为(274.18±44.16)mm Hg,组间差异有统计学意义(P<0.05)。用药后6h,两组患儿的P(A-a)O_2差值最大,至24 h后仍有较大差距。用药后1、6、12及24 h,两组患儿的FiO_2均降低,组间差异无统计学意义(P>0.05)。给予大剂量珂立苏后,患儿OI在较短时间内(用药后1 h)迅速下降,接近正常水平,而小剂量组患儿至用药后12 h逐渐恢复正常。用药后12 h大剂量组患儿X线评分降低,同时小剂量组患儿X线评分虽低于用药前,但与同时间点大剂量组患儿比较,仍有较大差异(P<0.05)。结论大剂量珂立苏治疗呼吸窘迫综合征成效显著,能够有效改善新生儿血气指标,具有安全可靠、临床操作性高的特点。

Objective To investigate the effects of Calsurf application dose for late neonatal respiratory distress syndrome. Methods Ninety-five cases of neonatal respiratory distress syndrome in our hospital between July 2014 and December 2015 were selected, and divided into large-dose group and small-dose group according to a random number table. Pa02, PaC02, P（Aa）02, FLOE, OI and X line scores before treatment, 1, 6, 12 and 24 h after treatment were compared between the two groups . Results Among the 48 cases in the high-dose group, 25 cases were cured, 21 cases were improved, 2 cases did not get curative effect, the total effective rate was 95.83%; while among the 47 cases of the low-dose group, 20 cases wefe cured, 19 cases were improved, 6 cases had no curative effect, 2 cases died, the total efficiency was 82.98 %. Before treatment, Pa02, PaC02, P（Aa）02, Fi02, OI or X ray score was not significantly different between the two groups （P 〉 0.05）. In the high-dose group Pa02 rapid recovered 1 h after treatment, and continued to rise 6 , 12 and 24 h after treatment; in the small-dose group Pa02 also increased, but the change was not obvious 1 h after treatment, Pa02 level was still significantly lower than that in the high-dose group 24 h after treatment. PaCO2 reduced in both groups within 1 h after administration, but the change was not obvious; 6 h after treatment PaC02 was significantly lower than that before treatment and maintained stable 12 and 24 h after administration. P（Aa）O： dropped to about 200 mmHg in the high-dose group 1 h after administration, and in the low-dose group, the average P（Aa）O~ was （274.18 ~ 44.16） mmHg, the difference was statistically significant （P 〈 0.05）. P （Aa）O： had the biggest difference between the two groups 6 h after drug intake, there was still big difference 24 h after treatment. After treatment for 1, 6, 12 and 24 h, Fi02 in the two groups was significantly lowered, the difference between the groups was not statistically significant （P 〉 0.05）. After administration of high doses of Calsurf, OI decreased rapidly 1 h after treatment to nearly normal level, while in the low dose group OI gradually returned to normal after 12 h. X-ray scores were significantly reduced in the high-dose group 12 h after administration, while X-ray scores in the small-dose group were significantly lower than those before treatment but there were still big differences from those in the high-dose group at the same time point（P 〈 0.05）. Conclusions Large-dose Calsurf has remarkable effect on respiratory distress syndrome. It can effectively improve neonatal blood indicators, and has the advantages of safety, reliability and high clinical operability.