PS联合布地奈德混悬液气管内滴入治疗新生儿重度胎粪吸入综合征应用价值分析

Clinical Value Analysis on Intratracheal Instillation of PS Combined with Budesonide Suspension in the Treatment of Neonatal Severe Meconium Aspiration Syndrome

目的探讨猪肺表面活性物质与布地奈德混悬液联合使用在新生儿胎粪吸入综合征(MAS)中的疗效及安全性。方法选取我院在2012年7月至2017年6月收治的80例新生儿重度胎粪吸入综合征患儿,采用前瞻性对照研究,按照随机数字表法分为观察组和对照组,各40例,对照组在患儿进入NICU后2 h内给予PS200 mg/kg(首剂)气管内滴入治疗;观察组在此基础上加用布地奈德悬混液(0.25 g/kg)治疗;对比两组患儿呼吸机使用时间、PS重复使用情况及临床有效率,记录治疗后2、12、24、48 h两组患儿血气分析结果,观察两组患儿住院时间及临床症状消失时间,随访两组患儿死亡率及并发症发生情况。结果 (1)观察组患儿在呼吸机使用时间、PS重复使用率方面明显低于对照组,临床有效率高于对照组,差异具有统计学意义(P<0.05);(2)观察组在住院时间、呼吸困难缓解时间、湿罗音消失时间、发绀消失时间方面明显短于对照组,差异具有统计学意义(P<0.05);(3)两组患者治疗后各时间点血气分析结果明显优于治疗前,且随着时间延长,PaO_2、PaO_2/FiO_2逐渐升高,PaCO_2、OI逐渐降低,差异具有统计学意义(P<0.05);且观察组在治疗后12、24、48 h血气分析结果明显优于对照组,差异具有统计学意义(P<0.05);(4)观察组并发症发生率和死亡率为7.50%、2.50%,对照组并发症发生率和死亡率为25.00%、15.00%,差异具有统计学意义(P<0.05)。结论 PS联合布地奈德混悬液气管内滴入治疗MAS效果显著,能够有效改善患儿血气分析结果,提高临床有效率,降低并发症发生率和死亡率,值得临床推广。

Objective To explore the efficacy and safety of porcine pulmonary surfactant（ PS） combined with budesonide suspension in neonatal meconium aspiration syndrome（ MAS）. Methods Eighty cases with severe neonatal MAS,treated in our hospital from July 2012 to June 2017,were selected and divided into the observation group and the control group（ with 40 cases in each group）according to the random number table method. With the prospective control study method,the control group received intratracheal instillation of PS 200 mg/kg（ first dose） within 2 hours after the neonates entered NICU; Besides that,the observation group was treated with budesonide suspension（ 0. 25 g/kg）. The ventilator use time,PS repeated usage and clinical efficiency were compared between the two groups. Blood gas analysis results of two groups were recorded at 2 h,12 h,24 h and 48 h after treatment. The hospitalization time and clinical symptom disappearance time of the two groups were observed. The mortality and complications of the two groups were followed up. Results（ 1） The use efficiency of ventilator and repeated use of PS in the observation group were significantly lower than those in the control group,and the clinical effective rate was higher than that of the control group. The differences were of statistical significance（ P〈0. 05）.（ 2） The hospitalization time,respiratory distress remission time,wet rales disappearing time and cyanosis disappearing time of the observation group was significantly shorter than those of the control group. The differences were of statistical significance（ P〈0. 05）.（ 3） The blood gas analysis results of the two groups at each time point after treatment were significantly better than those before treatment. With the extension of time,PaO_2 and PaO_2/FiO_2 gradually increased,while PaCO_2 and OI gradually decreased. The differences were statistically significant（ P〈0. 05）. The blood gas analysis results of the observation group at 12 h,24 h and 48 h after treatment were obviously better than those of the control group. The difference was statistically significant（ P〈0. 05）.（ 4） The incidence of complications and mortality in the observation group were 7. 50% and 2. 50% respectively. The incidence of complications and mortality in the control group were 25. 00% and 15. 00% respectively. The differences were statistically significant（ P〈0. 05）. Conclusion The effect of PS intratracheal instillation combined with budesonide suspension in the treatment of MAS is significant. It can effectively improve the blood gas analysis results in neonatal patients,improve the clinical efficiency,and reduce the incidence of complications and mortality. Therefore,it is worthy of clinical promotion.