小潮气量通气联合气管内抽吸胎粪治疗足月儿重症胎粪吸入综合征的效果观察

Effect of Small Tidal Volume Ventilation Combined with Intratracheal Meconium Aspiration on Severe Meconium Aspiration Syndrome in Term Infants

目的:探讨小潮气量通气联合气管内抽吸胎粪治疗足月儿重症胎粪吸入综合征(MAS)的效果。方法:选择2018年1月-2019年12月于本院分娩的足月MAS新生儿86例,将其随机分为研究组(n=43)与对照组(n=43)。均予以气管抽吸治疗,在此基础上对照组予以传统大潮气量通气,研究组则予以小潮气量通气,比较两组血气指标及整体治疗情况。结果:研究组治疗48 h的PaO_2水平显著高于对照组,PaCO_2水平显著低于对照组(P<0.05);研究组治疗48 h的血清IL-6水平显著低于对照组,IL-10水平显著高于对照组(P<0.05)。研究组治疗48 h的Raw、MAP均显著低于对照组,Cydn显著高于对照组,差异均有统计学意义(P<0.05)。研究组的上机时间、吸氧时间、胸片病灶消退时间、住院时间均显著短于对照组,差异均有统计学意义(P<0.05)。研究组的并发症发生率显著低于对照组(P<0.05)。结论:小潮气量通气联合气管内抽吸胎粪治疗可有效改善足月MAS新生儿的血气分析指标,减轻机体炎症反应状态,改善肺功能,减少并发症发生。

Objective:To explore the effect of small tidal volume ventilation combined with intratracheal meconium aspiration on term infants with severe meconium aspiration syndrome(MAS).Method:A total of 86 full-term MAS newborns delivered in our hospital from January 2018 to December 2019 were selected.They were randomly divided into study group(n=43)and control group(n=43).All patients were treated with tracheal aspiration,on this basis,the control group was treated with conventional high tidal ventilation,and the study group with small tidal ventilation.Blood gas index and overall treatment were compared between the two groups.Result:The level of PaO2 in the study group at 48 h for treatment was significantly higher than that in the control group,and the level of PaCO2 was significantly lower than that in the control group(P<0.05).The level of serum IL-6 in the study group was significantly lower than that in the control group at 48 h for treatment,and the level of IL-10 was significantly higher than that in the control group(P<0.05).The Raw and MAP of the study group were significantly lower than those of the control group,the Cydn of the study group was significantly higher than that of the control group,the differences were statistically significant(P<0.05).The computer time,oxygen inhalation time,chest radiograph subsidence time and hospitalization time of the study group were significantly shorter than those of the control group,the differences were statistically significant(P<0.05).The incidence of complications in study group was significantly lower than that of the control group(P<0.05).Conclusion:Small tidal volume ventilation combined with intratracheal meconium aspiration can effectively improve the blood gas analysis index of MAS full-term neonates,reduce the inflammatory response state of the body,improve lung function,reduce the incidence of complications.