HFOV联合牛肺表面活性剂对新生儿胎粪吸入综合征血气指标的影响

Effect of HFOV combined with bovine lung surfactant on blood gas index of meconium aspiration syndrome

目的探讨高频振荡通气(HFOV)联合牛肺表面活性剂(商品名:珂立苏)对新生儿胎粪吸入综合征(MAS)血气指标的影响。方法80例MAS患儿,按治疗方法不同分为对照组和观察组,各40例。对照组给予高频振荡通气治疗,观察组给予高频振荡通气联合牛肺表面活性剂治疗。对比两组患儿机械通气时间、氧疗时间、住院时间、不同时间新生儿行为神经评分表(NBNA)评分、并发症发生情况及治疗前后动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)及经皮血氧饱和度(SpO2)。结果治疗前,两组PaO2、PaCO2、SpO2比较差异无统计学意义(P>0.05);治疗后,观察组PaO2(84.59±11.03)mm Hg(1 mm Hg=0.133 kPa)、SpO2(97.46±2.92)%均高于对照组的(75.46±11.24)mm Hg、(92.46±2.49)%,PaCO2(46.49±4.58)mm Hg低于对照组的(58.67±4.61)mm Hg,差异有统计学意义(P<0.05)。观察组机械通气时间(4.37±0.61)d、氧疗时间(11.25±1.39)d及住院时间(12.58±1.19)d均短于对照组的(7.15±1.28)、(16.48±1.46)、(18.24±1.51)d,差异有统计学意义(P<0.05)。出院时,两组NBNA评分比较差异无统计学意义(P>0.05);出院3个月,观察组NBNA评分(38.41±0.68)分高于对照组的(35.96±0.71)分,差异有统计学意义(P<0.05)。观察组并发症发生率2.50%低于对照组的17.50%,差异有统计学意义(P<0.05)。结论高频振荡通气联合牛肺表面活性剂治疗新生儿MAS效果显著,血气指标明显改善,值得推广。

Objective To discuss the effect of high frequency oscillation ventilation(HFOV)combined with bovine lung surfactant(trade name:Kelisu)on blood gas index of meconium aspiration syndrome(MAS).Methods A total of 80 MAS children were divided into control group and observation group by different treatment methods,with 40 cases in each group.The control group was treated by high frequency oscillation ventilation,and the observation group was treated by high frequency oscillation ventilation combined with bovine lung surfactant.Comparison was made on mechanical ventilation time,oxygen therapy time,hospitalization time,neonatal behavior neurological assessment(NBNA)score at different time,occurrence of complications,arterial oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2)and blood oxygen saturation(SpO2)before and after treatment between the two groups.Results Before treatment,there was no statistically significant difference in PaO2,PaCO2 and SpO2 between the two groups(P>0.05).After treatment,the PaO2(84.59±11.03)mm Hg(1 mm Hg=0.133 kPa),SpO2(97.46±2.92)%in the observation group was higher than(75.46±11.24)mm Hg and(92.46±2.49)%in the control group,and PaCO2(46.49±4.58)mm Hg was lower than(58.67±4.61)mm Hg in the control group.Their difference was statistically significant(P<0.05).The mechanical ventilation time(4.37±0.61)d,oxygen therapy time(11.25±1.39)d and hospitalization time(12.58±1.19)d was shorter than(7.15±1.28),(16.48±1.46)and(18.24±1.51)d in the control group,and their difference was statistically significant(P<0.05).At discharge,there was no statistically significant difference in NBNA score between the two groups(P>0.05).At 3 months after discharge,the NBNA score(38.41±0.68)points in the observation group was higher than(35.96±0.71)points in the control group,and the difference was statistically significant(P<0.05).The incidence of complications 2.50%in the observation group was lower than 17.5%in the control group,and the difference was statistically significant(P<0.05).Conclusion High frequency oscillation ventilation combined with bovine lung surfactant shows significant effect in the treatment of neonatal MAS,and it can obviously improve the blood gas index.It is worthy of promotion.