支气管肺泡灌洗在治疗重症新生儿肺炎和胎粪吸入综合征中的应用价值

Application value of bronchoalveolar lavage in treating severe neonatal pneumonia and meconium aspiration syndrome

目的探索BAL在治疗重症新生儿肺炎(PN)、胎粪吸入综合征(MAS)中的应用价值。方法选取2018年3月至2020年10月该院收治的重症PN患儿60例、MAS患儿65例为研究对象。两种疾病分为肺表面活性物质(PS)灌洗组、生理盐水(NS)灌洗组、无灌洗组,采用肺脏超声(LUS)进行肺部疾病影像学检查、监测。比较重症PN、MAS患儿各组间肺复张时间、有创呼吸机治疗时间、第1次撤机成功率、存活率,气漏、肺出血等并发症发生情况,治疗前、治疗后第1、12、24小时氧合指数(OI)。结果重症PN、MAS患儿PS灌洗组肺复张时间、有创呼吸机治疗时间较NS灌洗组、无灌洗组短,NS灌洗组较无灌洗组短,差异有统计学意义(P<0.05);各组间第1次撤机成功率、存活率差异无统计学意义(P>0.05);PS灌洗组OI较NS灌洗组、无灌洗组降低,NS灌洗组较无灌洗组降低,差异有统计学意义(P<0.05);各组并发症发生率比较差异无统计学意义(P>0.05)。结论BAL治疗重症PN、MAS有效,外源性PS灌洗优于NS灌洗。

Objective To explore the application value of bronchoalveolar lavage(BAL)in treating severe pneumonia of newborns(PN)and meconium aspiration syndrome(MAS).Methods Sixty children patients with severe PN and 65 children patients with MAS in this hospital from March 2018 to October 2020 were selected as the research subjects.The patients with two diseases were randomly divided into the pulmonary surfactant(PS)lavage group,normal saline(NS)lavage group,normal saline(NS)lavage group and non-lavage group.The lung ultrasound(LUS)was adopted to conduct the lung disease imaging examination and monitor.The pulmonary reexpansion time,invasive ventilator treatment time,success rate of the first ventilator withdrawal,survival rate,occurrence of complications such as air leak and pneumorrhagia were compared among the various groups of severe PN and MAS.The oxygenation indexes(OI)before treatment and at 1,12,24 h after treatment were compared.Results The pulmonary reexpansion time and invasive ventilator treatment time of the PS lavage group among the children patients with severe PN and MAS were shorter than those of the NS lavage group and non-lavage group,the NS lavage group was shorter than the non-lavage group,and the differences were statistically significant(P<0.05).The success rate of the first ventilator withdrawal and survival rate had no statistical difference among the various groups(P>0.05).The OI level in the PS lavage group was decreased compared with that in the NS lavage group and non-lavage group and the NS lavage group was decreased compared with the non-lavage group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in the occurrence rate of complications among the various groups(P>0.05).Conclusion BAL is effective in the treatment of severe PN and MAS.The exogenous PS lavage is supeior to the NS lavage.