不同剂量猪肺磷脂注射液雾化吸入联合无创辅助通气治疗早产儿呼吸窘迫综合征疗效观察

Effect of different doses of poractant alfa injection atomization inhalation combined with non-invasive auxiliary ventilation in the treatment of premature infants with respiratory distress syndrome

目的探讨不同剂量猪肺磷脂注射液雾化吸入联合无创辅助通气治疗早产儿呼吸窘迫综合征(RDS)的临床疗效。方法选择2019年1月至2019年12月解放军总医院第七医学中心儿科医学部收治的212例RDS早产儿为研究对象。根据治疗方法的不同将患儿分为低剂量组(n=104)和高剂量组(n=108)。2组患儿均给予无创辅助通气治疗,在此基础,低剂量组患儿给予100 mg·kg^(-1)猪肺磷脂注射液雾化吸入,高剂量组患儿给予200 mg·kg^(-1)猪肺磷脂注射液雾化吸入。采用动脉血气分析仪检测2组患儿治疗前及治疗后12 h的动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))及pH值。采用常频呼吸机内置肺功能仪检测2组患儿治疗前、治疗后12 h氧合指数、肺顺应性及吸气阻力。记录2组患儿治疗期间支气管肺发育不良、肺出血、肺气漏、严重颅内出血、反复呼吸暂停、早产儿视网膜病变发生情况,并计算不良反应总发生率。结果治疗前,2组患儿PaO_(2)、PaCO_(2)、pH值比较差异无统计学意义(P>0.05)。治疗后12 h,2组患儿PaO_(2)显著高于治疗前,PaCO_(2)显著低于治疗前(P<0.05);2组患儿治疗后12 h的pH值与治疗前比较差异无统计学意义(P>0.05)。治疗后12 h,高剂量组患儿PaO_(2)显著高于低剂量组,PaCO_(2)显著低于低剂量组(P<0.05);2组患儿治疗后12 h的pH值比较差异均无统计学意义(P>0.05)。治疗前2组患儿氧合指数、肺顺应性、吸气阻力比较差异无统计学意义(P>0.05)。治疗后12 h,2组患儿氧合指数、肺顺应性显著高于治疗前,吸气阻力显著低于治疗前(P<0.05);治疗后12 h,高剂量组患儿氧合指数、肺顺应性显著高于低剂量组,吸气阻力显著低于低剂量组(P<0.05)。低剂量组与高剂量组患儿的支气管肺发育不良、肺出血、肺气漏、严重颅内出血、反复呼吸暂停、早产儿视网膜病变发生率及不良反应总发生率比较差异均无统计学意义(χ^(2)=1.946、0.005、1.578、0.731、2.196、3.139,P>0.05)。结论与100 mg·kg^(-1)猪肺磷脂注射液雾化吸入联合无创辅助通气治疗相比,200 mg·kg^(-1)猪肺磷脂注射液雾化吸入联合无创辅助通气治疗早产儿RDS可显著改善患儿血气指标及呼吸力学指标。

Objective To explore the clinical effect of different doses of poractant alfa injection atomization inhalation combined with noninvasive auxiliary ventilation in the treatment of premature infants with respiratory distress syndrome(RDS).Methods A total of 212 premature infants with RDS admitted to the Department of Pediatrics,the Seventh Medical Center of PLA General Hospital from January 2019 to December 2019 were selected as the research objects.The children were divided into low-dose group(n=104)and high-dose group(n=108)according to different treatment.All patients were give non-invasive auxiliary ventilation,based on this,the children in the low-dose group were given 100 mg·kg^(-1) poractant alfa injection atomization inhalation and the children in the high-dose group were given 200 mg·kg^(-1) poractant alfa injection atomization inhalation.Before treatment and 12 hours after treatment,the arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))and pH of children in the two groups were detected by arterial blood gas analyzer.Before treatment and 12 hours after treatment,the oxygenation index,lung compliance and inspiratory resistance of children in the two groups were measured by built-in pulmonary function meter in a regular-frequency ventilator.During the treatment,the occurrence of bronchopulmonary dysplasia,pulmonary hemorrhage,pulmonary air leakage,severe intracranial hemorrhage,repeated apneas and retinopathy of children in the two groups were recorded,and the total incidence of adverse reactions was calculated.Results There was no significant difference in PaO_(2),PaCO_(2)and pH of children between the two groups before treatment(P>0.05);at 12 hours after treatment,the PaO_(2)of children in the two groups was significantly higher than that before treatment,and the PaCO_(2)was significantly lower than that before treatment(P<0.05);there was no significant difference in pH of children in the two groups before treatment and 12 hours after treatment(P>0.05);at 12 hours after treatment,the PaO_(2)of children in the high-dose group was significantly higher than that in the low-dose group,and the PaCO_(2)was significantly lower than that in the low-dose group(P<0.05);at 12 hours after treatment,there was no significant difference in pH of children between the two groups(P>0.05).There was no significant difference in oxygenation index,lung compliance and inspiratory resistance of children between the two groups before treatment(P>0.05);at 12 hours after treatment,the oxygenation index and lung compliance of children in the two groups were significantly higher than those before treatment,and the inspiratory resistance was significantly lower than that before treatment(P<0.05);at 12 hours after treatment,the oxygenation index and lung compliance of children in the high-dose group were significantly higher than those in the low-dose group,and the inspiratory resistance was significantly lower than that in the low-dose group(P<0.05).There was no significant difference in the incidence of bronchopulmonary dysplasia,pulmonary hemorrhage,pulmonary air leakage,severe intracranial hemorrhage,repeated apnea,retinopathy of prematurity and the total incidence of adverse reactions of children between the low-dose group and the high-dose group(χ^(2)=1.946,0.005,1.578,0.731,2.196,3.139;P>0.05).Conclusion Compared with the 100 mg·kg^(-1) poractant alfa injection atomization inhalation combined with non-invasive auxiliary ventilation therapy,200 mg·kg^(-1) poractant alfa injection atomization inhalation combined with non-invasive auxiliary ventilation can significantly improve blood gas indexes and respiratory mechanics index of preterm infants with RDS.