不同剂量猪肺磷脂注射液治疗新生儿呼吸窘迫综合征的临床疗效

Clinical effect of different doses of poractant alfa injection in treating neonatal respiratory distress syndrome

目的探讨不同剂量猪肺磷脂注射液治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选取成都西区安琪儿妇产医院2016年8月—2017年3月收治的NRDS患儿68例,随机分为对照组和治疗组,各34例。对照组患儿给予猪肺磷脂注射液100 mg/kg,治疗组患儿给予猪肺磷脂注射液200 mg/kg,两组患儿均持续治疗48 h。比较两组患儿治疗前后pH值、血二氧化碳分压(PaCO_2)、血氧分压(PaO_2)及吸入氧浓度(FiO_2)变化情况;临床效果(机械通气情况、氧疗时间、辅助通气时间及呼吸困难持续时间);并发症(慢性肺部疾病、肺出血、动脉导管未闭、脑室内出血)及病死率情况。结果治疗前及治疗48 h后,两组患儿pH值、PaCO_2、PaO_2比较,差异无统计学意义(P>0.05);治疗3、12、24 h后,治疗组患儿pH值、PaO_2高于对照组,PaCO_2低于对照组(P<0.05)。治疗前,两组患儿FiO_2水平比较,差异无统计学意义(P>0.05),治疗后,治疗组患者FiO_2水平低于对照组(P<0.05)。两组患儿机械通气所占比例比较,差异无统计学意义(P>0.05);治疗组患儿氧疗时间、辅助通气时间及呼吸困难持续时间短于对照组(P<0.05)。两组患儿慢性肺疾病、肺出血、动脉导管未闭、脑室内出血发生率及患儿病死率比较,差异无统计学意义(P>0.05)。结论对于已确诊NRDS的早产儿,200 mg/kg的猪肺磷脂注射液可更有效改善患儿的血气指标,降低FiO_2,缩短患儿机械通气时间、氧疗时间及呼吸困难持续时间,且安全性好。

Objective To investigate the clinical effect of different doses of poractant alfa injection in treating neonatal respiratory distress syndrome（ NRDS）. Methods A total of 68 cases of NRDS children were selected from August 2016 to March 2017 in Angel Women and Children ＇s Hospital of Chengdu West District,which were randomly divided into control group and treatment group,34 cases in each group. The control group was treated with 100 mg/kg,treatment group was treated with 200 mg/kg,both groups were treated for 48 h. The pH,PaCO2,PaO2,FiO2 before and after treatment; clinical effect（ mechanical ventilation,oxygen therapy time,assisted ventilation time,duration of dyspnea）; the occurrence of complications（ chronic lung disease,pulmonary hemorrhage,patent ductus arteriosus,intraventricular hemorrhage,fatality rate） were compared between the two groups. Results Before and after treatment of 48 h,no significant differences of pH,PaCO2 or PaO2 was found between the two groups（ P〉0. 05）; after treatment of 3,12,24 h,the treatment group of pH,PaO2 were higher than control group,PaCO2 was lower than control group（ P〈0. 05）. Before treatment,no significant difference of FiO2 levels was found between the two groups（ P〉0. 05）; after treatment,the FiO2 levels of treatment group was lower than control group（ P〈0. 05）. There was no significant difference of mechanical ventilation rate between the two groups（ P〉0. 05）; the oxygen therapy time,assisted ventilation time,duration of dyspnea of treatment group were shorter than control group（ P〈0. 05）. No significant differences of the incidence rate of chronic lung disease,pulmonary hemorrhage,patent ductus arteriosus,intraventricular hemorrhage and fatality rate was found between the two groups（ P〉0. 05）. Conclusion As for NRDS children,200 mg/kg poractant alfa injection therapy can more effectively improve blood gas indexes of children,reduce the FiO2 levels,and shorten oxygen therapy time,assisted ventilation time,duration of dyspnea,and with good safety.