注射用牛肺表面活性剂不同给药方式在新生儿胎粪吸入综合征中的应用

Application of different administration modes of bovine pulmonary surfactant for injection in neonatal meconium inhalation syndrome

目的探讨注射用牛肺表面活性剂不同给药方式在新生儿胎粪吸入综合征(MAS)中的应用效果。方法回顾性分析2021年3月至2023年3月南阳市第一人民医院收治的120例MAS患儿的临床资料,根据给药方式不同分为A组和B组各60例。A组患儿采用肺泡灌洗+气管内滴入给药,B组患儿采用气管内滴入给药,连续治疗48 h。比较两组患儿的临床疗效,以及治疗前后的血气指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧指数(OI)]、肺动脉收缩压(SPAP)、凝血纤溶指标[D-二聚体(D-D)、纤溶酶原激活抑制剂-1(PAI-1)/组织型纤溶酶原激活物(t-PA)、血小板活化因子(PAF)]、炎症因子[肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、白细胞介素-5(IL-5)、白细胞介素-13(IL-13)]水平,同时比较两组患者的康复相关指标和并发症发生情况。结果A组患儿的治疗总有效率为91.67%,明显高于B组的76.67%,差异有统计学意义(P<0.05);治疗后,A组患儿的PaO_(2)为(60.65±6.33)mmHg,明显高于B组的(56.12±5.93)mmHg,PaCO_(2)、OI、SPAP分别为(42.36±4.02)mmHg、13.10±1.12、(26.14±2.67)mmHg,明显低于B组的(45.66±4.33)mmHg、(15.66±1.53)、(29.46±3.11)mmHg,差异均有统计学意义(P<0.05);治疗后,A组患儿的血浆D-D、PAI-1/t-PA、PAF含量分别为(1.35±0.38)mg/L、3.52±0.78、(404.55±78.78)×10^(9)/L,明显高于B组的(1.00±0.31)mg/L、2.64±0.71、(340.59±65.33)×10^(9)/L,差异均有统计学意义(P<0.05);治疗后,A组患儿的血清TNF-α、PCT、IL-5、IL-13含量分别为(11.11±1.01)ng/L、(0.78±0.23)ng/mL、(0.90±0.34)pg/mL、(1.15±0.66)pg/mL,明显低于B组的(13.75±1.63)ng/L、(1.46±0.34)ng/mL、(1.50±0.40)pg/mL、(1.63±0.94)pg/mL,差异均有统计学意义(P<0.05);A组患儿的发绀、吸气性三凹征消失时间及氧疗时间、住院时间、机械通气时间明显短于B组,差异均有统计学意义(P<0.05);A组患者的并发症总发生率为1.67%,明显低于B组的15.00%,差异有统计学意义(P<0.05)。结论相较于气管内滴入给药,注射用牛肺表面活性剂肺泡灌洗+气管内滴入给药治疗MAS患儿的治疗效果更优,其可促进血气指标、凝血纤溶指标恢复,降低肺动脉高压,减轻机体炎性损伤,降低并发症发生率。

Objective To investigate the effects of different administration modes of bovine pulmonary surfactant for injection in neonatal meconium aspiration syndrome(MAS).Methods The clinical data of 120 children with MAS treated in Nanyang First People's Hospital from March 2021 to March 2023 were retrospectively analyzed,and they were divided into group A and group B according to different administration methods,each with 60 cases.Children in group A were treated with pulmonary alveolar lavage with bovine pulmonary surfactant for injection plus intratracheal drip administration,and those in group B were treated with intratracheal drip administration,both for 48 h.The clinical efficacy,rehabilitation-related indicators,and complications of the two groups were compared,as well as blood gas indexes[partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygen index(OI)],pulmonary artery systolic blood pressure(SPAP),coagulation fibrinolytic index[D-dimer(D-D)],plasminogen activator inhibitor-1(PAI-1)/tissue plasminogen activator(t-PA),platelet-activating factor(PAF),inflammatory factors[tumor necrosis factor-α(TNF-α),procalcitonin(PCT),interleukin-5(IL-5),interleukin-13(IL-13)]levels before and after treatment.Results The total effective rate of group A was 91.67%,which was significantly higher than 76.67%of group B(P<0.05).After treatment,PaO_(2)in group A was(60.65±6.33)mmHg,which was significantly higher than(56.12±5.93)mmHg in group B,and Pa-CO_(2),OI,and SPAP were(42.36±4.02)mmHg,13.10±1.12,and(26.14±2.67)mmHg,respectively,which were signifidoicantly lower than(45.66±4.33)mmHg,15.66±1.53,and(29.46±3.11)mmHg in group B,with statistically significant differences(P<0.05).After treatment,the plasma D-D,PAI-1/t-PA,and PAF levels in group A were(1.35±0.38)mg/L,3.52±0.78,and(404.55±78.78)×10^(9)/L,respectively,which were significantly higher than(1.00±0.31)mg/L,2.64±0.71,(340.59±65.33)×10^(9)/L in group B(P<0.05).After treatment,the serum levels of TNF-α,PCT,IL-5,and IL-13 in group A were(11.11±1.01)ng/L,(0.78±0.23)ng/mL,(0.90±0.34)pg/mL,and(1.15±0.66)pg/mL,respectively,which were significantly lower than(13.75±1.63)ng/L,(1.46±0.34)ng/mL,(1.50±0.40)pg/mL,(1.63±0.94)pg/mL in group B(P<0.05).The disappearance time of cyanosis and inspiratory three concave signs,oxygen therapy time,length of hospital time,and mechanical ventilation time in group A were significantly shorter than those in group B,and the differences were statistically significant(P<0.05).The total incidence of complications in group A was 1.67%,which was significantly lower than 15.00%in group B(P<0.05).Conclusion Compared with intratracheal drip administration,pulmonary alveolar lavage with bovine pulmonary surfactant for injection plus intratracheal drip administration has a better therapeutic effect in the treatment of MAS children,which can promote the recovery of blood gas index and coagulation and fibrinolytic index,reduce pulmonary hypertension,alleviate inflammatory injury,and reduce the incidence of complications.