肺表面活性物质联合布地奈德治疗重症呼吸窘迫综合征早产儿的效果

Effect of pulmonary surfactant combined with Budesonide in treatment of premature infants with neonatal respiratory distress syndrome

目的探讨肺表面活性物质(PS)联合布地奈德治疗重症呼吸窘迫综合征(NRDS)早产儿的临床效果和对动脉血气状况的影响。方法选取2019年7月—2020年7月济南市莱芜人民医院收治的98例重症NRDS早产儿,按随机数字表法将其分为两组,每组各49例。两组均予以常规治疗,对照组加用PS治疗,观察组于对照组基础上予以布地奈德治疗。比较两组患儿的动脉血气状况、呼吸机相关参数、通气相关指标和不良反应发生情况。结果两组患儿治疗前的动脉血气指标、呼吸机相关参数比较,差异无统计学意义(P>0.05);两组患儿治疗后的血氧分压(PaO_(2))、氧合指数(OI)均高于治疗前,二氧化碳分压(PaCO_(2))均低于治疗前,且观察组患儿治疗后的PaO_(2)为(81.79±6.79)mmHg,OI为(283.69±19.13)mmHg,均高于对照组的(76.68±6.34)、(264.41±17.76)mmHg,PaCO_(2)为(40.52±4.58)mmHg,低于对照组的(45.31±4.62)mmHg,差异有统计学意义(P<0.05);两组患儿治疗后的吸气峰压(PIP)、吸入氧浓度(FiO_(2))、呼吸频率(RR)均低于治疗前,且观察组患儿治疗后的PIP为(17.89±1.86)cmH_(2)O,FiO_(2)为(29.68±4.05)%,RR为(35.42±4.31)次/min,均低于对照组的(19.65±2.02)cmH_(2)O、(33.71±4.27)%、(40.28±4.65)次/min,差异有统计学意义(P<0.05);观察组患儿的有创通气时间为(3.25±0.42)d,撤机时间为(27.69±3.65)d,住院时间为(40.13±5.62)d,均短于对照组的(4.51±0.86)、(31.14±3.85)、(46.85±5.79)d,差异有统计学意义(P<0.05);两组患儿的不良反应总发生率比较,差异无统计学意义(P>0.05),两组患儿均未发生严重不良反应,经过对症处理后未影响治疗。结论PS联合布地奈德可增强重症NRDS患儿的治疗效果,改善动脉血气指标,纠正机体缺氧状态,减轻呼吸支持负担,缩短撤机时间,安全可靠。

Objective To investigate the clinical effect of pulmonary surfactant(PS)combined with Budesonide in the treatment of premature infants with neonatal respiratory distress syndrome(NRDS)and its effect on arterial blood gas status.Methods A total of 98 premature infants with severe NRDS admitted to Jinan Laiwu People′s Hospital from July 2019 to July 2020 were selected and divided into two groups according to random number table method,with 49 cases in each group.Both groups were given routine treatment,the control group was additionally treated with PS,and the observation group was additionally treated with Budesonide on the basis of PS treatment.The arterial blood gas status,ventilator related parameters,ventilation related indexes and adverse reactions were compared between the two groups.Results Before treatment,there were no significant differences in arterial blood gas index and ventilator related parameters between the two groups(P>0.05).The partial blood oxygen pressure(PaO_(2))and oxygenation index(OI)of the two groups after treatment were higher than those before treatment,and the partial blood carbon dioxide pressure(PaCO_(2))of the two groups after treatment was lower than that before treatment,the PaO_(2) and OI of the observation group after treatment were(81.79±6.79)mmHg and(283.69±19.13)mmHg,which were higher than those of the control group,which were(76.68±6.34)and(264.41±17.76)mmHg,PaCO_(2) of the observation group after treatment was(40.52±4.58)mmHg,lower than that of the control group of(45.31±4.62)mmHg,and the differences were statistically significant(P<0.05).After treatment,the peak inspiratory pressure(PIP),inhaled oxygen concentration(FiO_(2))and respiratory rate(RR)of the two groups were all lower than those before treatment,and the PIP,FiO_(2) and RR of the observation group were(17.89±1.86)cmH_(2)O,(29.68±4.05)%and(35.42±4.31)times/min after treatment,which were lower than those in the control group of(19.65±2.02)cmH_(2)O,(33.71±4.27)%,(40.28±4.65)times/min,and the differences were statistically significant(P<0.05).The invasive ventilation time of the observation group was(3.25±0.42)d,weaning time of the observation group was(27.69±3.65)d,and hospitalization time of the observation group was(40.13±5.62)d,which were all shorter than those of the control group of(4.51±0.86),(31.14±3.85)and(46.85±5.79)d,the differences were statistically significant(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05),and no serious adverse reactions occurred in the two groups,which did not affect the treatment after symptomatic treatment.Conclusion PS combined with Budesonide can enhance the treatment effect of children with severe NRDS,improve the arterial blood gas index,correct the body′s hypoxia state,reduce the burden of respiratory support,and shorten the weaning time.It is safe and reliable.