肺表面活性物质联合经鼻导管高流量氧疗治疗新生儿重症肺炎疗效研究

Efficacy of pulmonary surfactant combined with high-flow nasal cannula oxygen therapy in the treatment of neonatal severe pneumonia

目的探讨肺表面活性物质联合经鼻导管高流量氧疗治疗新生儿重症肺炎的疗效。方法选取自2020年3月至2021年1月收治的117例新生儿重症肺炎患儿为研究对象,采用随机数字表法分为A组(n=58)与B组(n=59)。两组患儿均给予镇静、抗感染、营养支持、纠正水电解质失衡、保持呼吸道顺畅、保护脏器功能等对症治疗。同时,A组患儿给予经鼻导管高流量氧疗;B组患儿在A组治疗基础上联合肺表面活性物质治疗。评估并比较两组患儿治疗效果。记录并比较两组患儿治疗前、后血气指标[氧分压(PaO_(2))及二氧化碳分压(PaCO_(2))]、炎症指标[血清白细胞介素6(IL-6)、白细胞介素10(IL-10)、C反应蛋白(CRP)]水平。记录并比较两组患儿临床指标改善时间(肺部啰音消失时间、感染控制时间、心率恢复正常时间及呼吸困难缓解时间)、ICU住院时间,以及并发症、不良反应发生情况。结果B组患儿治疗总有效率为94.9%(56/59),显著高于A组的82.8%(48/58),差异有统计学意义(P<0.05)。治疗后,两组患儿PaO_(2)水平较治疗前升高,且B组高于A组;两组患儿PaCO_(2)水平较治疗前降低,且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组患儿IL-6、IL-10、CRP水平均治疗前降低,且B组低于A组,差异有统计学意义(P<0.05)。B组患儿肺部啰音消失时间、感染控制时间、心率恢复正常时间、呼吸困难缓解时间及ICU住院时间均短于A组,差异有统计学意义(P<0.05)。B组患儿并发症发生率为6.8%(4/59),低于A组的22.4%(13/58),差异有统计学意义(P<0.05)。两组患儿均未发生不良反应。结论肺表面活性物质联合经鼻导管高流量氧疗治疗新生儿重症肺炎效果较好,并发症少,安全性高,且有助于患儿恢复。

Objective To investigate the efficacy of pulmonary surfactant combined with high-flow nasal cannula oxygen therapy in the treatment of neonatal severe pneumonia.Methods A total of 117 children with neonatal severe pneumonia admitted from March 2020 to January 2021 were selected and divided into Group A(n=58)and Group B(n=59)by random number table.Both two groups of children were given symptomatic treatments,including sedation,anti-infection,nutritional support,correction of water and electrolyte imbalance,keeping respiratory tract smooth,protecting organ function and etc.At the same time,Group A was treated with high-flow nasal cannula oxygen therapy,while Group B was combined with pulmonary surfactant on the basic of group A.To evaluate and compare the treatment effect between the two groups.Blood gas indexes[partial pressure of oxygen(PaO_(2))and partial pressure of carbon dioxide(PaCO_(2))],inflammatory indexes[serum interleukin 6(IL-6),interleukin 10(IL-10),C-reactive protein(CRP)]were recorded and compared between the two groups before and after the treatment.The improvement time of clinical indicators(lung rales disappear time,infection control time,heart rate return to normal time and dyspnea relief time),ICU hospitalization time,and the occurrence of complications and adverse reactions were recorded and compared between the two groups.Results The total effective rate in Group B was 94.9%(56/59),significantly higher than that in Group A(82.8%,48/58),and the difference was statistically significant(P<0.05).After the treatment,the level of PaO_(2)in the two groups was higher than before,and that in Group B was significantly higher than that in Group A(P<0.05).After the treatment,the level of PaCO_(2)in the two groups was lower than before,and that in Group B was significantly lower than that in Group A(P<0.05).After the treatment,the levels of IL-6,IL-10 and CRP in the two groups were decreased,and those in Group B were significantly lower than those in Group A(P<0.05).The disappearance time of pulmonary rales,infection control time,heart rate return to normal time,dyspnea relief time and ICU hospitalization time in Group B were shorter than those in Group A,and the differences were statistically significant(P<0.05).The incidence of complications in Group B was 6.8%(4/59),lower than that in group A(22.4%,13/58),and the difference was statistically significant(P<0.05).There were no adverse reactions in the two groups.Conclusion Pulmonary surfactant combined with with high-flow nasal cannula oxygen therapy in the treatment of neonatal severe pneumonia has a good effect,fewer complications,high safety.It is conducive to the recovery of children.