不同通气方式联合牛肺磷脂注射液治疗新生儿胎粪吸入综合征的对比研究

Comparative study of different ventilation modes combined with bovine lung phospholipid injection in the treatment of neonatal meconium inhalation syndrome

目的:对比不同通气方式联合牛肺磷脂注射液治疗新生儿胎粪吸入综合征(MAS)的应用效果。方法:回顾性收集我院88例MAS患儿(2018年1月~2020年12月)临床资料,按照治疗方式不同分组,44例采用经鼻双相正压通气(N-BiPAP)+牛肺磷脂注射液治疗为A组,44例采用经鼻持续正压通气(NCPAP)+牛肺磷脂注射液治疗为B组,比较两组氧疗时间、通气时间、并发症发生率及治疗前、治疗2 d血气指标[二氧化碳分压(PaCO_(2))、氧分压(PaO2)、氧和指数(OI)]、炎症因子水平[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)]、血管内皮功能[内皮素-1(ET-1)、一氧化氮(NO)]。结果:A组氧疗、通气时间较B组短(P<0.05);治疗2 d后A组PaO_(2)、OI较B组高,PaCO_(2)较B组低(P<0.05);治疗2 d后A组血清TNF-α、IL-6水平较B组低,血清IL-10水平较B组高(P<0.05);治疗2 d后A组血清ET-1水平较B组低,血清NO水平较B组高(P<0.05);两组并发症发生率比较无明显差异(P>0.05)。结论:与NCPAP相比,N-BiPAP联合牛肺磷脂注射液治疗MAS患儿可有效缩短氧疗、通气时间,改善呼吸状态,减轻机体炎症及血管内皮损伤,且安全性高。

Objective:To compare the effect of different ventilation modes combined with bovine lung phospholipid injection in the treatment of neonatal meconium inhalation syndrome(MAS).Methods:Clinical data of 88 children with MAS in our hospital(January 2018 to December 2020)were retrospectively collected.According to different treatment methods,44 children were divided into group A who were treated with n-BIPAP+bovine lung phospholipid injection.44 patients were treated with NCPAP+bovine lung phospholipid injection in group B.The oxygen therapy time,ventilation time,complication rate,blood gas indexes before and two days after operation[partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),oxygen and oxygen index(OI)],levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),interleukin-6(IL-6)],vascular endothelial function[endothelin-1(ET-1),nitric oxide(NO)]were compared between the two groups.Results:The oxygen therapy and ventilation time of group A were shorter than that of group B(P<0.05).After 2 days of treatment,PaO_(2)and OI in group A were higher than those in group B,and PaCO_(2)was lower than those in group B(P<0.05).The levels of serum TNF-αand IL-6 in group A were lower than those in group B,and the levels of serum IL-10 were higher than those in group B(P<0.05).After 2 days of treatment,the serum ET-1 level in group A was lower than that in group B,and the serum NO level was higher than that in group B(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Compared with NCPAP,N-BiPAP combined with bovine lung phospholipid injection can effectively shorten oxygen therapy and ventilation time,improve respiratory status,reduce inflammation and vascular endothelial injury in children with MAS,and has a high safety.