新生儿重症胎粪吸入综合征呼吸机联合肺表面活性物质治疗的疗效及预后分析

Efficacy and prognosis of neonatal severe meconium aspiration syndrome ventilator combined with pulmonary surfactant treatment

目的 :研究分析新生儿重症胎粪吸入综合征(MAS)呼吸机联合肺表面活性物质(PS)治疗的疗效及预后情况。方法 :根据随机数字表法将我院于2015年5月~2017年6月期间接诊的112例新生儿重症MAS患儿分为对照组(56例)、研究组(56例)。对照组患者给予呼吸机机械通气治疗,研究组患者在对照组治疗基础上联合应用PS进行治疗。将两组呼吸机参数、血气分析、炎症因子、合并症及转归情况展开对比分析。结果 :联合组平均气道压力(MAP)、吸入氧体积分数(Fi O2)、峰压(PIP)及上机时间较对照组低,差异有统计学意义;治疗后2h、12h、24h联合组二氧化碳分压(PCO2)、白细胞介素-10(IL-10)水平较对照组高,氧分压(PO2)、IL-8水平较对照组低,差异有统计学意义;联合组缺氧缺血性脑病(HIE)、脑室内出血(IVH)及死亡率略低于对照组,差异无统计学意义;联合组呼吸机相关性肺炎(VAP)、肺气漏发生率与对照组相比均较低,差异有统计学意义。结论 :新生儿重症MAS采用呼吸机联合PS治疗利于缩短治疗时间,改善血气分析,减弱炎症反应,降低合并症及死亡风险,利于预后。

Objective To evaluate the efficacy and prognosis of neonatal severe meconium aspiration syndrome(MAS) ventilator combined with pulmonary surfactant(PS). Methods According to the random number table method, 112 cases of neonatal severe MAS children admitted to our hospital from May 2015 to June 2017 were divided into control group(56 cases) and study group(56 cases). The patients in the control group were treated with ventilator mechanical ventilation, and the patients in the study group were treated with PS on the basis of treatment in the control group. The ventilator parameters, blood gas analysis, inflammatory factors, comorbidities and outcome were compared and analyzed in both groups. Results The mean airway pressure(MAP), inhalation oxygen volume fraction(Fi O2), peak pressure(PIP) and on the machine were lower than those in the control group. The levels of PCO2 and IL-10 in the combined group were higher than those in the control group at 2 h, 12 h and 24 h after treatment, and the levels of oxygen partial pressure(PO2) and IL-8 were lower than those in the control group. There was no significant difference between the two groups in hypoxic-ischemic encephalopathy and intraventricular hemorrhage and mortality. The incidence of ventilator-associated pneumonia(VAP) and pulmonary air leakage in the combined group were lower than those in the control group. Conclusion Neonatal severe MAS with ventilator combined with PS treatment will help shorten the treatment time, improve blood gas analysis, reduce the inflammatory response, reduce the risk of complications and death.