| 摘要: |
| 目的：探讨重症胎粪吸入综合征（MAS）的有效治疗方法。方法：选取2004年9月至2014年12月我院新生儿科治疗的重症MAS患儿64例，按治疗方案分为高频振荡通气（HFOV）+肺表面活性物质（PS）组、常频机械通气（CMV）+PS组、HFOV组、CMV组四组各16例，四组辅助处理措施相同。PS为注射用牛肺表面活性剂（Calsurf），在气管插管后以100 mg/kg气管内给药，患儿依次取平卧位、左侧卧位、右侧卧位、平卧位，每个体位均注入总剂量的1/4，为防止药物黏滞导致气道阻塞，注药时采用复苏囊加压通气，注药完毕后继续接呼吸机辅助通气。观察记录四组患儿治疗前后不同时间点的血气分析、PaO2/FiO2、氧合指数（OI）及机械通气时间、住院时间、转归情况。结果：HFOV+PS组死亡2例，CMV+PS组死亡3例，HFOV组死亡3例，CMV组死亡4例，其他患儿均治愈出院，四组患儿的转归情况比较差异无统计学意义（P>0.05）。四组患儿治疗前（0 h）pH、PaO2、PaCO2、PaO2/FiO2、OI比较差异无统计学意义（P>0.05），均随着治疗时间的延长而逐渐改善，其中HFOV+PS组改善最为显著，其在治疗2、12、24、48 h时与另三组比较差异均有统计学意义（P均<0.05）。HFOV+PS组的平均机械通气时间是（93.6±41.2）h，平均住院时间是（15.8±5.1）d，均短于另三组（P均<0.05）。结论：HFOV联合PS治疗重症MAS，可迅速改善通气和氧合功能，缩短机械通气时间和住院时间，值得临床推广应用。 |
| 关键词: 重症 胎粪吸入综合征 高频振荡通气 注射用牛肺表面活性剂 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.02.009 |
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| 基金项目: |
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| Clinical Therapeutic Effect Observation on the Treatment of Severe Meconium Aspiration Syndrome with High Frequency Oscillation Ventilation and Calf Pulmonary Surfactant for Injection |
| Xu Minghao1, Liu Chengjun2, Xu Feng2, Du Xingqin1 |
| (1.Pingdingshan Maternal and Child Health Hospital, Henan Province, Henan Pingdingshan 467000, China; 2. Children’s HosPital of Chongging Medical University, Chongging 400014, China) |
| Abstract: |
| Objective: To observe the clinical therapeutic effect of severe meconium aspiration syndrome (MAS) with high frequency oscillatory ventilation (HFOV) and calf pulmonary surfactant for injection (PS). Methods: 64 pediatric patients with severe MAS during September 2004 to December 2014 were randomly chosen according to four groups, each group of each 16 examples. There are no significant difference about the clinical data of each group. The four group patients were given the same the same basic treatment. On this basis, group 1 were administered with HFOV+PS, group 2 were administered with CMV and Calsurf, group 3 were administered with HFOV, group 4 were administered with CMV,. Solid dosage of surfactant: 100 mg/kg intratracheal to drug after tracheal intubation, children in turn supine, left lateral, right lateral decubitus position, supine position, each position were injected 1/4 of the total dose, in order to prevent drug viscosity lead to airway obstruction and drug injection in the resuscitation bag pressurized ventilation, after injection to ventilator assisted ventilation. Then points of blood gas analysis at different time, PaO2, PaO2/FiO2, OI, the duration of mechanical ventilation and length of hospital stay were observed. Results: HFOV+PS group died in 2 cases, CMV+PS group died in 3 cases, HFOV group died in 3 cases, CMV group died in 4 cases, other children were cured. There was no significant difference in outcome of the four groups (P>0.05). Before treatment, there was no statistical difierence of points of blood gas analysis at different time, PaO2, PaO2/FiO2, and OI among the four groups. After treatment, Points of blood gas analysis at different time, PaO2, PaO2/FiO2, and OI of the four groups was improved gradually over time. After 2 hours of treatment, concrete data in the HFOV+PS group started to significantly improved [pH: 7.05±0.23 to 7.29±0.10; PaO2: (42.1±5.8) mm Hg to (58.7±9.8) mm Hg; PaCO2: (63.9±7.1) mm Hg to (44.3±5.1) mm Hg, PaO2/FiO2: 58.7±7.7 to 90.7±8.2, OI: 30.7±6.2 to 20.5±4.10), but the other groups did not improved so obviously. After treatment for 2 hours, 12 hours, 24 hours, 48 hours, there was significant difference of the points of blood gas analysis at different time, PaO2, PaO2/FiO2, and OI in the HFOV+PS group compared with the other groups. The average mechanical ventilation time of HFOV+PS group was (93.6±41.2) h, the average hospitalization time was (15.8±5.1) days, The difference was statistically significant (P<0.05) with the other three groups. Conclusion: Application of HFOV+PS for treatment of severe MAS can rapidly improve ventilation and oxygenation, significantly reduce mechanical ventilation time, reduce complications, effectively, improve the clinical symptoms and show a certain effect on severe MAS.It is worthy of clinical application. |
| Key words: Severe Meconium aspiration syndrome High frequency oscillatory ventilation Calf pulmonary surfactant for injection |
