注射用牛肺表面活性剂与猪肺磷脂注射液替代治疗对早产儿呼吸窘迫综合征患者呼吸、神经系统的影响

Effects of two kinds of pulmonary surfactant pathway replacement therapy on the breathe and nervous system in preterm infants

目的探讨两种肺泡表面活性物质(PS)替代治疗对早产儿呼吸、神经系统的影响。方法 2013年2月—2016年12月选择在中山市博爱医院诊治的早产儿呼吸窘迫综合征97例作为研究对象,根据随机数字表法分为观察组48例与对照组49例,对照组给予猪肺磷脂注射液(固尔苏)治疗,观察组治疗给予注射用牛肺表面活性剂(珂立苏),在给药途径中,不中断进行机械通气,此后根据患儿临床表现与呼吸困难改善情况可重复使用,最大使用次数不超过3次;两组都治疗观察14 d。记录并比较两组的机械通气时间、住院天数与住院费用,两组治疗前后的肺泡内正压参数变化情况,行为神经测定(NBNA)评分及神经损伤因子情况。结果观察组的通气时间、氧疗时间与住院时间都明显少于对照组,差异有统计学意义(P<0.05)。治疗后观察组与对照组的肺泡内正压参数都明显低于治疗前,同组治疗前后比较差异有统计学意义(P<0.05);同时治疗后观察组的肺泡内正压参数明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组与对照组的纠正胎龄37周时NBNA评分分别为(36.98±3.11)分和(31.49±3.87)分,都明显高于治疗前的(25.72±2.92)分和(25.14±3.11)分,同组治疗前后比较差异有统计学意义(P<0.05);且治疗后观察组的NBNA评分明显高于对照组,差异有统计学意义(P<0.05)。治疗后观察组与对照组的血清NSE含量明显低于治疗前,同组治疗前后比较差异有统计学意义(P<0.05);治疗后观察组的血清NSE含量也明显低于对照组,差异有统计学意义(P<0.05)。结论不中断机械通气给予注射用牛肺表面活性剂能改善呼吸窘迫综合征患儿的肺功能,促进患儿康复,且有利于患儿神经功能的恢复,有很好的应用价值。

Objective To investigate the effects of two kinds of pulmonary surfactant（PS） pathway replacement therapy on the breathe and nervous system in preterm infants. Methods From February 2013 to December 2016, 97 cases of preterm infants acute lung injury in our hospital diagnosis and treatment were selected and were randomly divided into observation group of 48 cases and 49 cases in the control group, the control group was given curosurf treatment, the observation group was given kelisu treatment, all the PS were rewarming to 37℃, the first dose were 200 mg/kg, then were given additional dose accorded to the clinical manifestations of the patients with disease rehabilitation, the highest dose of 400 mg/kg; two groups were treated with 14 d. ResultsThe ventilation time, oxygen treatment time and hospitalization time in the observation group were significantly less than those of the control group（P〈0.05）. After treatment, the positive alveolar pressure parameters of the observation group and the control group were significantly lower than that before treatment（P〈0.05）, while the observation group were significantly lower than that of the control group（P〈0.05）. After treatment, the NBNA scores（correct fetal age 37 weeks） in the observation group and the control group were（36.98 ± 3.11） points and（31.49 ± 3.87） points, were significantly higher than that before treatment of（25.72 ± 2.92） points and（25.14 ± 3.11） points（P〈0.05）, and the observation group was significantly higher than the control group（P〈0.05）. After treatment, the serum NSE contents of the observation group and the control group was significantly lower than that before treatment（P〈0.05）, and the serum NSE content in the observation group was also significantly lower than that in the control group（P〈0.05）. Conclusion Kelisu in the treatment of preterm infants acute lung injury without interruption of mechanical ventilation can improve the pulmonary function, promote the rehabilitation of children, and improve the neurological function of children with acute lung injury, it has good application values.