氨溴索联合不同通气方式治疗早产儿呼吸窘迫综合征临床效果的比较

Comparison of clinical effect of ambroxol combined with different ventilation modes in treatment of preterm infants with respiratory distress syndrome

目的探索在早产儿呼吸窘迫综合征中氨溴索联合机械通气的多种通气模式的疗效区别。方法前瞻性纳入2013年1月-2018年1月之间就诊于本院的75例呼吸窘迫综合征早产儿患者,所有患儿均随机进入不同机械通气模式组,其中采用常规机械通气(conventional mechanical ventilation,CMV)为36例、高频振荡通气(high frequency oscillatory ventilation,HFOV)为39例。两组患者自治疗开始均联合静脉氨溴索(剂量为30mg/kg)治疗。结果HFOV组患儿机械通气治疗1、12、24h后动脉氧分压(PaO 2)、动脉血氧分压/吸入氧体积分数(PaO 2/FiO 2)、氧和指数(OI)、肺泡-动脉血氧分压比(a/APO 2)的改善均明显优于CMV组(P<0.05)。两组之间死亡率和机械通气时间均无明显统计学差异,气胸、支气管肺发育不良、早产儿视网膜病、脑室内出血、脑室周围白质软化等并发症也无统计学差异(P>0.05)。结论静脉氨溴索联合高频振荡通气对改善早产儿呼吸窘迫综合征氧和肺呼吸功能优于常规机械通气。

Objective To investigate the effectiveness of ambroxol combined with different modes of mechanical ventilation in treatment of premature infants with respiratory distress syndrome.Methods 75 premature infants diagnosed with respiratory distress syndrome were involved in the present study from January 2013 to January 2018.All involved subjects were supported by mechanical ventilation and randomly divided into the high frequency oscillatory ventilation group(HFOV,n=39)and the conventional mechanical ventilation group(CMV,n=36).All of them were given ambroxol intravenously at a dosage of 30 mg/kg body weight.Results Compared to the CMV group,their pulmonary arterial oxygen tension(PaO 2),PaO 2/fraction of inspired oxygen(FiO 2)ratio,oxygenation index(OI)and arterial/alveolar oxygen partial pressure ratio(a/APO 2)of the patients in the HFOV group 1,12 and 24 h after treatment were significantly improved in the HFOV group(P<0.05).However,there was no significant difference in mortality or ventilation time between the two groups.The incidence of complications such as pneumothorax,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),intraventricular hemorrhage(IVH)and periventricular leukomalacia(PVL)showed no significant difference between the two groups(P>0.05).Conclusion Ambroxol combined with HFOV secretolytic therapy can significantly improve arterial blood gas levels,oxygenation and respiratory function of lungs in preterm respiratory distress syndrome in premature infants.