牛肺表面活性物质在新生儿胎粪吸入综合征中的应用

Application of bovine pulmonary surfactant in neonatal meconium aspiration syndrome

目的 :探讨牛肺表面活性物质(pulmonary surfactant, PS)在新生儿胎粪吸入综合征(meconium aspiration syndrome, MAS)患者机械通气中的应用效果和短期预后情况。方法:选取2014年1月—2020年3月于安徽省妇幼保健院行机械通气干预的胎粪吸入综合征新生儿69例为研究对象,分为观察组42例和对照组27例。对照组采用抗生素预防感染、营养支持以及常频机械通气等。观察组在对照组治疗基础上,经气管导管给予PS注入干预,总剂量为100 mg/kg体质量。分别在机械通气干预后的1、6、12 h,比较两组氧合指数(oxygenation index, OI)、动脉血氧分压(arterial oxygen tension, PaO_(2))、二氧化碳分压(arterial carbon dioxide tension, PaCO2)、心率(heart rate, HR)等指标变化,统计两组7 d内的死亡率和气胸发生率改变。结果:与对照组比较,观察组机械通气后的1、6、12 h的OI和PaO_(2)均较对照组显著升高,同期PaCO2显著降低(P<0.05)。观察组7 d死亡率为2.38%,低于对照组(11.11%)(P<0.05),但两组气胸发生率差异无统计学意义(P>0.05)。结论:PS在机械通气中的应用,改善MAS患者的短期预后和降低7 d内的死亡率,值得临床推广应用。

Objective:To investigate the application effect and short-term prognosis of bovine pulmonary surfactant(PS)in neonatal meconium aspiration syndrome(MAS)patients with mechanical ventilation.Methods:A total of 69 neonates with meconium aspiration syndrome who underwent mechanical ventilation in Anhui Maternal and Child Health Hospital from January 2014 to March 2020 were selected and divided into observation group(42 cases)and control group(27 cases).The control group used antibiotics to prevent infection,nutritional support and frequent mechanical ventilation.On the basis of the control group,the observation group was given PS injection via tracheal catheter,and the total dose was 100 mg/kg body weight.At 1,6 and 12 h after mechanical ventilation intervention,the changes of oxygenation index(OI),arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),and heart rate(HR)were compared between the two groups,and the changes of mortality rate and pneumothorax incidence within 7 days were counted.Results:Compared with the control group,the OI and PaO_(2) in the observation group were significantly increased at 1,6 and 12 h after mechanical ventilation,and PaCO_(2) was significantly decreased at the same time(P<0.05).The 7-day mortality rate of the observation group(2.38%,1/42)was lower than that of the control group(11.11%,3/27)(P<0.05),but there was no significant difference in the incidence of pneumothorax between the two groups(P>0.05).Conclusion:The application of PS in mechanical ventilation can improve the short-term prognosis of MAS patients and reduce the mortality within 7 days,which is worthy of clinical application.