蛇毒血凝酶不同给药途径联合HFOV治疗新生儿肺出血的效果

Effect of different administration routes of snake venom hemagglutinin combined with HFOV on neonatal pulmonary hemorrhage

目的探讨不同途径给予蛇毒血凝酶联合高频振荡通气(HFOV)治疗新生儿肺出血(NPH)的效果及对凝血功能、葡萄糖-6-磷酸脱氢酶(G6PD)、Ⅱ型肺泡细胞表面抗原(KL-6)的影响。方法选取2021年1月至2023年6月该院收治的102例NPH患儿,将其分为研究组和对照组,各51例。两组均给予HFOV治疗,在此基础上,对照组经静脉推注给予蛇毒血凝酶治疗,研究组经静脉推注联合气管内滴入给予蛇毒血凝酶治疗。比较两组治疗效果、肺出血停止时间、机械通气时间、住院时间、治疗前后动脉血氧分压(PaO_(2))、活化部分凝血活酶时间(APTT)、PaO_(2)与吸入氧浓度比(PaO_(2)/FiO_(2))、D-二聚体(D-D)、动脉血二氧化碳分压(PaCO_(2))、凝血酶原时间(PT)、pH值、纤维蛋白原降解产物(FDP)和血清G6PD、KL-6水平及并发症发生率。结果研究组总有效率[94.12%(48/51)]高于对照组[980.39%(41/51)],差异有统计学意义(P<0.05);研究组肺出血停止时间、住院时间、机械通气时间均短于对照组,差异有统计学意义(P<0.05);治疗后24、72 h,研究组PaO_(2)/FiO_(2)、PaO_(2)、pH值高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05);治疗后24、72 h,与对照组相比,研究组D-D、KL-6、FDP水平较低,APTT、PT较短,G6PD较高,差异有统计学意义(P<0.05);研究组并发症发生率[5.88%(3/51)]低于对照组[19.61%(11/51)],差异有统计学意义(P<0.05)。结论蛇毒血凝酶经静脉推注与气管内滴入给药方式联合应用于NPH中,可调节患儿凝血功能及血清KL-6、G6PD水平,改善血氧指标,降低并发症风险,促进病情恢复,临床应用效果良好。

Objective To explore the effect of different ways of giving snake venom hemagglutination enzyme combined with high frequency oscillatory ventilation(HFOV)on neonatal pulmonary hemorrhage(NPH)and its influence on coagulation function,glucose-6-phosphate dehydrogenase(G6PD)and typeⅡalveolar cell surface antigen(KL-6).Methods A total of 102 NPH from January 2021 to June 2023 were selected and divided into the study group and the control group,51 cases in each group.Both groups were given HFOV treatment,on this basis,the control group was given snake venom hemthrombin by intravenous injection,and the study group was given snake venom hemthrombin by intravenous injection combined with intratracheal drip.The treatment effect,pulmonary hemorrhage stop time,mechanical ventilation time,hospital stay of the two groups were compared,as well as arterial partial oxygen pressure(PaO_(2)),activated partial thromboplastin time(APTT),PaO_(2)to inhaled oxygen concentration ratio(PaO_(2)/FiO_(2)),D-dimer(D-D),arterial partial carbon dioxide pressure(PaCO_(2)),prothrombin time(PT),pH value,fibrinogen degradation products(FDP),serum G6PD,KL-6 levels and complication rate before and after treatment.Results The total effective rate of the study group was[94.12%(48/51)]higher than that of the control group[80.39%(41/51)],and the difference was statistically significant(P<0.05).The pulmonary hemorrhage stopping time,hospital stay time and mechanical ventilation time in the study group were shorter than those in the control group(P<0.05).Moreover,at 24 h and 72 h after treatment,PaO_(2)/FiO_(2),PaO_(2)and pH values of the study group were higher than those of the control group,and PaCO_(2)was lower than those of the control group,and the differences were statistically significant(P<0.05).At 24 h and 72 h after treatment,the D-D,KL-6,FDP,APTT and PT of the study group were lower than those of the control group,and G6PD was higher than that of the control group,and the differences were statistically significant(P<0.05).The complication rate of the study group[5.88%(3/51)]was lower than that of the control group[19.61%(11/51)],and the difference was statistically significant(P<0.05).Conclusion The combination of intravenous injection of snake venom hemagglutinase and intratracheal infusion in NPH can regulate the blood coagulation function,serum KL-6 and G6PD levels in children,improve blood oxygen index,reduce the risk of complications,and promote disease recovery,and the clinical application effect is good.