牛肺表面活性剂不同给药途径对重症新生儿胎粪吸入综合征的影响研究

Effects of different administration routes of bovine lung surfactants on severe neonatal meconium aspiration syndrome

目的观察牛肺表面活性剂不同给药途径对重症新生儿胎粪吸入综合征(MAS)的影响。方法本研究为前瞻性研究,选择商丘市第一人民医院2021年3月至2023年6月收治的85例MAS患儿为研究对象,以计算机随机分组法将其分为常规组(42例)和双途径组(43例),常规组采用机械通气结合气管内滴入牛肺表面活性剂治疗,双途径组通过牛肺表面活性剂支气管肺泡灌洗结合气管内滴入治疗,比较两组患儿的炎症因子、血气指标、血管内皮功能变化情况,治疗后康复情况及并发症发生情况。结果治疗后,双途径组的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)分别为(114.45±10.27)ng/mL、(60.45±10.31)pg/mL、(45.15±10.27)ng/mL,均低于常规组[(121.36±10.25)ng/mL、(65.27±10.36)pg/mL、(50.33±10.24)ng/mL](P<0.05);双途径组的动脉氧分压(PO_(2))、血氧饱和度(SaO_(2))分别为(92.44±10.45)mmHg、(95.18±5.26)%,均高于常规组[(87.32±10.46)mmHg、(92.55±5.46)%](P<0.05);动脉二氧化碳分压(PCO_(2))[(40.24±10.33)mmHg]低于常规组[(45.11±10.19)mmHg](P<0.05);双途径组的一氧化氮(NO)[(23.25±5.77)ppb]高于常规组[(20.47±5.16)ppb](P<0.05),内皮素-1(ET-1)[(50.62±10.39)ng/L]低于常规组[(55.47±10.28)ng/L](P<0.05);双途径组的通气时间、氧疗时间、住院时间分别为(3.36±0.24)d、(6.65±1.33)d、(10.33±2.26)d,均低于常规组[(4.18±1.77)d、(8.12±2.54)d、(14.42±4.15)d](P<0.05);双途径组的并发症发生率[9.30%(4/43)]低于常规组[23.81%(10/42)](P<0.05)。结论牛肺表面活性剂肺泡灌洗+气管内滴入给药有利于改善MAS患儿的气道炎症及肺部血气指标,可一定程度上减轻血管内皮细胞损伤、加快康复进程并改善患儿预后。

【Objective】To observe the effect of different administration routes of bovine lung surfactant on severe neonatal meconium aspiration syndrome(MAS).【Methods】This study is a prospective study,selecting 85 children with MAS admitted in the First People's Hospital of Shangqiu City between March 2021 and June 2023 as the study subjects.They were randomly divided into a conventional group(42 cases)and a dual pathway group(43 cases)using computer randomization.The conventional group received mechanical ventilation combined with tracheal instillation of bovine lung surfactant,while the dual pathway group received mechanical ventilation combined with bronchoalveolar lavage and tracheal instillation of bovine lung surfactant.The changes in inflammatory factors,blood gas indicators,vascular endothelial function,recovery after treatment,and incidence of complications between the two groups of children were compared.【Results】After treatment,the levels of IL-6,IL-8,and IL-10 in the dual pathway group were 114.45±10.27 ng/mL,60.45±10.31 pg/mL,and 45.15±10.27 ng/mL,lower than the conventional group(121.36±10.25 ng/mL,65.27±10.36 pg/mL,and 50.33±10.24 ng/mL)(P<0.05).The PO_(2) and SaO_(2) levels in the dual pathway group were 92.44±10.45 mmHg and 95.18%±5.26%,higher than the conventional group(87.32±10.46 mmHg and 92.55%±5.46%)(P<0.05).PCO_(2) in the dual pathway group(40.24±10.33 mmHg)was lower than that of the conventional group(45.11±10.19 mmHg)(P<0.05).The NO in the dual pathway group(23.25±5.77 ppb)was higher than the conventional group(20.47±5.16 ppb),while the ET-1(50.62±10.39 ng/L)was lower than the conventional group(55.47±10.28 ng/L)(P<0.05).The ventilation time,oxygen therapy time,and hospitalization time of the dual pathway group were 3.36±0.24 days,6.65±1.33 days,and 10.33±2.26 days,lower than the conventional group(4.18±1.77 days,8.12±2.54 days,and 14.42±4.15 days)(P<0.05).The incidence of complications in the dual pathway group was 9.30%(4/43),lower than that in the conventional group[23.81%(10/42)](P<0.05).【Conclusion】The dual pathway administration of bovine lung surfactant can effectively alleviate the inflammatory response and blood gas indicators in children with MAS,which has a positive significance in reducing vascular endothelial cell damage,accelerating the recovery process,and reducing the risk of complications.