猪肺磷脂注射液与氨溴索分别联合经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征的疗效

Poractant Alfa Injection or Ambroxol Combined with Nasal Continuous Positive Airway Pressure in the Treatment of Respiratory Distress Syndrome

目的:探讨猪肺磷脂注射液与氨溴索分别联合鼻塞式持续气道正压通气(n CPAP)治疗新生儿呼吸窘迫综合征(NRDS的疗效及对患儿血气指标及氧合指标的影响。方法:采用随机数表法将90例NRDS患儿分为研究组和对照组各45例。研究组患儿予以猪肺磷脂注射液+n CPAP治疗,对照组患儿予以氨溴索+n CPAP治疗,比较两组临床疗效,观察治疗前后动脉血气指标[p H、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)]、氧合指数(OI)、平均气道压(MAP)及血清炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)]水平及并发症发生情况。结果:研究组治疗总有效率91. 11%,高于对照组的73. 33%,研究组并发症发生率11. 11%,低于对照组的28. 89%(P<0. 05);治疗后24 h,研究组患儿p H、PaO2、OI水平分别为7. 36±0. 05、(76. 48±11. 06) mm Hg、(278. 51±18. 32) mm Hg,高于治疗前的7. 15±0. 06、(41. 03±8. 32) mm Hg、(74. 61±10. 23) mm Hg,且高于对照组的7. 27±0. 07、(67. 35±10. 29) mm Hg、(231. 25±17. 43) mm Hg(P<0. 05);治疗后24 h,PaCO2、MAP水平分别为(45. 15±7. 59) mm Hg、(6. 43±1. 64) cm H2O,低于治疗前的(61. 72±10. 23) mm Hg、(8. 67±2. 03) cm H2O,且低于对照组的(53. 14±8. 76) mm Hg、(7. 32±1. 85) cm H2O(P<0. 05);治疗后24 h,研究组患儿血清TNF-α水平为(78. 41±11. 36) ng/L,较治疗前的(57. 26±10. 32) ng/L升高,低于对照组的(90. 52±12. 89) ng/L(P<0. 05);治疗后24 h,IL-10水平为(34. 78±6. 59) ng/L,较治疗前的(40. 13±7. 21) ng/L降低,高于对照组的(21. 56±5. 47) ng/L(P<0. 05)。结论:猪肺磷脂注射液联合n CPAP治疗NRDS的疗效优于氨溴索联合n CPAP,能更有效的改善患儿的血气指标和氧合水平,减轻机体炎症反应,并进一步降低并发症发生率。

Objective:To probe into the efficacy of poractant alfa injection or ambroxol combined with nasal continuous positive airway pressure(n CPAP)in the treatment of respiratory distress syndrome(RDS)and its effects on blood gas and oxygenation indexes.Methods:Totally 90 children with RDS were extracted to be divided into the research group and the control group via the random number table,with 45 cases in each group.The research group was treated with poractant alfa injection combined with n CPAP,while the control group was given ambroxol combined with n CPAP.The clinical efficacy of two groups were compared,arterial blood gas index such as p H,arterial oxygen partial pressure(PaO2)and arterial blood carbon dioxide partial pressure(PaCO2),oxygenation index(OI),mean airway pressure(MAP)and serum inflammatory factors such as tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)levels before and after treatment and complications of two groups were observed.Results:The total effective rate of the research group was 91.11%,higher than that of the control group(73.33%),and the complication rate of the research group was 11.11%,lower than that of the control group(28.89%,P<0.05).At 24 h after treatment,the levels of p H,PaO2 and OI with 7.36±0.05,(76.48±11.06)mm Hg and(278.51±18.32)mm Hg in the research group were significantly higher than those before treatment with 7.15±0.06,(41.03±8.32)mm Hg and(74.61±10.23)mm Hg,and higher than those in the control group with 7.27±0.07,(67.35±10.29)mm Hg and(231.25±17.43)mm Hg(P<0.05).The levels of PaCO2 and MAP with(45.15±7.59)mm Hg and(6.43±1.64)cm H2 O in the research group were lower than those before treatment with(61.72±10.23)mm Hg and(8.67±2.03)cm H2 O,and were lower than those in the control group with(53.14±8.76)mm Hg and(7.32±1.85)cm H2 O(P<0.05).The serum level of TNF-αwith(78.41±11.36)ng/L in the research group was higher than that before treatment with(57.26±10.32)ng/L,and was lower than that in the control group with(90.52±12.89)ng/L(P<0.05),and the level of IL-10 with(34.78±6.59)ng/L was lower than that before treatment with(40.13±7.21)ng/L,and was higher than that in the control group with(21.56±5.47)ng/L(P<0.05).Conclusion:The efficacy of poractant alfa injection combined with n CPAP in the treatment of neonatal RDS is better than that of ambroxol combined with n CPAP,which can effectively improve the blood gas index and oxygenation level of children,reduce the inflammatory response,and further reduce the incidence of complications.