雾化吸入N-乙酰半胱氨酸联合肺表面活性物质治疗新生儿重症胎粪吸入综合征的临床研究

Clinical study on atomization inhalation of N-acetylcysteine combined with pulmonary surfactant in the treatment of neonatal severe meconium aspiration syndrome

目的探讨雾化吸入N-乙酰半胱氨酸(NAC)联合肺表面活性物质(PS)治疗新生儿重症胎粪吸入综合征(MAS)的临床效果。方法选取2014年2月—2020年1月于安徽省淮北市矿工总医院收治的重症MAS患儿78例,根据随机数字表法分为对照组(n=39)和研究组(n=39)。对照组给予常规治疗+PS,研究组在对照组的基础上联合NAC治疗,比较两组患儿临床指标、血气分析指标、炎症因子指标及并发症发生情况。结果研究组住院时间、上呼吸机时间、氧暴露时间均短于对照组(P<0.05)。两组患儿治疗12、24 h后动脉血二氧化碳分压、氧合功能指数逐渐下降,且研究组低于对照组(P<0.05);动脉血氧分压逐渐升高,且研究组高于对照组(P<0.05)。两组患儿治疗12、24 h后白介素-8逐渐下降,且研究组低于对照组(P<0.05);白介素-10逐渐升高,且研究组高于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论雾化吸入NAC联合PS治疗新生儿重症MAS,可有效改善症状、血气分析指标及炎症因子指标,同时不增加不良反应发生率,具有较高的临床应用价值。

Objective To investigate clinical effect of atomization inhalation of N-acetylcysteine(NAC)combined with pulmonary surfactant(PS)in the treatment of neonatal severe meconium aspiration syndrome(MAS).Methods Seventy-eight children with severe MAS admitted to Huaibei Miner General Hospital in Anhui Province from February 2014 to January 2020 were selected and divided into control group(n=39)and study group(n=39)according to random number table method.Control group was given conventional treatment and PS,and study group was treated with NAC on the basis of control group.Clinical indexes,blood gas analysis indexes,inflammatory factors and complications were compared between two groups.Results The time of hospitalization,ventilation and oxygen exposure in study group were shorter than those in control group(P<0.05).The partial pressure of arterial blood carbon dioxide and oxygenation index of two groups decreased gradually after 12 hours and 24 hours of treatment,and study group was lower than the control group(P<0.05),arterial oxygen partial pressure increased gradually,and study group was higher than that control group(P<0.05).The level of interleukin-8 decreased gradually in two groups after 12 hours and 24 hours of treatment,and study group was lower than that control group(P<0.05).The level of interleukin-10 increased gradually,study group was higher than the control group(P<0.05).There was no significant difference in the incidence rate of complication between two groups(P>0.05).Conclusion Atomization inhalation of NAC combined with PS in the treatment of neonatal severe MAS can effectively improve the symptoms,blood gas analysis index and inflammatory factor index,and without increasing the incidence of adverse reactions,it has high clinical application value.