注射用牛肺表面活性剂联合经鼻持续正压通气治疗新生儿肺透明膜病的疗效及对呼吸力学的影响

Efficacy of Bovine Pulmonary Surfactant for Injection Combined with Nasal Continuous Positive Pressure Ventilation in the Treatment of Neonatal Hyaline Membrane Disease and its Effect on Respiratory Mechanics

目的:探讨应用注射用牛肺表面活性剂联合经鼻持续正压通气(NCPAP)治疗新生儿肺透明膜病(HMD)的效果。方法:选取2018—2020年5月普宁市妇幼保健计划生育服务中心收活的90例HMD患儿按照随机数表法分成观察组与对照组各45例,两组患儿均进行基础治疗,对照组在此基础上应用NCPAP治疗,而观察组则在NCPAP治疗的基础上加用注射用牛肺表面活性剂治疗,比较两组患儿治疗效果及治疗前后呼吸力学指标变化。结果:观察组患儿93.33%的治疗总有效率明显高于对照组,差异有统计学意义(χ^(2)=5.414,P<0.05)。两组患儿治疗1 d、3 d的动脉血氧分压(PaO)较之治疗前提高,而观察组治疗1 d、3 d的PaO高于对照组,差异有统计学意义(t=7.027,P<0.05)。治疗治疗1 d、3 d的动脉血二氧化碳分压(PaCO)较治疗前降低,观察组治疗1 d、3 d的PaCO低于对照组,差异有统计学意义(t=4.579,6.212,P<0.05)。观察组患儿治疗后Cstat、Insp Flow指标水平明显低于对照组患儿治疗后,差异有统计学意义(t=11.987,17.757,P<0.05)。两组患儿治疗前后RCexp指标水平,差异无统计学意义(t=1.119,P>0.05)。观察组患儿在通气时间、氧疗时间、住院时间均短于对照组,差异有统计学意义(t=17.374、11.034、12.277,P<0.05)。观察组患儿不良反应总发生率8.89%较之对照组11.11%。结论:采取注射用牛肺表面活性剂联合NCPAP治疗HMD的效果显著,可改善患儿呼吸力学指标,值得推广。

Objective: To investigate the effect of injectable bovine pulmonary surfactant + nasal continuous positive airway pressure(NCPAP) in the treatment of neonatal hyaline membrane disease(HMD). Methods: According to the random number table method, 90 children with HMD were divided into an observation group and a control group, with 45 cases in each group. Both groups received basic treatment. The control group was treated with NCPAP on this basis, while the observation group was treated with bovine lung surfactant for injection on the basis of NCPAP treatment. The treatment effect and the changes of respiratory mechanics indexes before and after treatment were compared between the two groups. Results: The total effective rate of children in the observation group was significantly higher than that in the control group, and the difference was statistically significant(χ^(2)=5.414, P<0.05). The arterial partial pressure of oxygen(PaO) of the two groups of children on 1 d and 3 d of treatment was higher than that before treatment, while the PaOof the observation group on 1 d and 3 d of treatment was higher than that of the control group, and the difference was statistically significant(t=7.027, P<0.05). The arterial partial pressure of carbon dioxide(PaCO) on the 1st and 3rd day of treatment was lower than that before treatment, and the PaCOin the observation group on the 1st and 3rd day of treatment was lower than that in the control group, and the difference was statistically significant(t=4.579, 6.212, P<0.05).The levels of Cstat and Insp Flow in the observation group were significantly lower than those in the control group after treatment,and the difference was statistically significant(t=11.987, 17.757, P<0.05). There was no statistically significant difference in the levels of RCexp between the two groups before and after treatment(t=1.119, P>0.05). The ventilation time, oxygen therapy time and hospitalization time of the observation group were shorter than those of the control group, and the difference was statistically significant(t=17.374, 11.034, 12.277, P<0.05). Conclusion: The use of bovine lung surfactant for injection combined with NCPAP in the treatment of HMD has a significant effect, and can improve the respiratory mechanics indexes of children, which is worthy of promotion.