【摘要】 目的研究猪肺表面活性物质(PS)气管内灌洗治疗重症新生儿胎粪吸入综合征的临床疗效。方法将本科2010年1月至2013年6月收治的足月儿重症MAS 136例,按Apgar评分0~3、4~7、≥8分进行分层,然后随机分为PS气管内灌洗治疗组(灌洗组)和PS气管内注入治疗组(注入组),各68例。灌洗组采用稀释后的PS 3~5 ml/次(浓度12 mg/ml)气管内灌洗;注入组采用PS原液200 mg/kg(首剂)气管内注入。比较两组患儿治疗前及治疗后2、12、24、48小时的血气分析、氧合指数(OI)值、吸入氧浓度比(P/F)比值的动态变化,比较两组患儿的上机时间、并发症、治愈率。结果灌洗组在PS使用前和使用后2小时的PaO2、PaCO2、OI值、P/F比值与注入组相比差异均无显著性(P>0.05),但在PS使用后的12、24、48小时上述指标灌洗组均要优于注入组(P<0.01)。灌洗组的上机时间(65.2±11.8)小时,注入组为(78.6±13.5)小时(t=6.12,P<0.01);灌洗组治愈66/68(97.1%),注入组治愈60/68(88.2%)(χ2=3.89,P<0.05);灌洗组并发症2/68(2.9%);注入组并发症9/68(13.2%)(χ2=4.85,P<0.05)。结论 PS稀释后进行气管内灌洗在改善通气和提高氧合效率方面优于PS气管内注入,并可减少上机时间,减少并发症,提高治愈率,且安全有效,值得临床上推广应用。更多还原

【Abstract】 Objective To explore the clinical effect of endotracheal lavage with porcine pulmonary surfactant(PS) among newborns with severe meconium aspiration syndrome. Method 136 term infants with severe meconium aspiration syndrome from January, 2010 to June, 2013 were enrolled at our department. All the cases were stratified into 3 groups based on Apgar score of 0-3,4-7,and≥8,And then, all the 136 cases were randomly divided into two groups:PS endotracheal lavage group(lavage group,68 cases) and PS intratracheal injection group(injection group,68 cases).Lavage group was treated with 3-5 ml PS attenuant every time(concentration:12 mg/ml), while injection group with 200 mg/kg PS original fluid(first dose).The data about Blood gas analysis,oxygen index(OI) and PaO2/ FiO2(P/F)were collected and compared before treatment and 2h,12h,24h, and 48 h after treatment. The data about the duration of mechanical ventilation,the complication rate and the cure rate were also compared. Result There was no significant difference on PaO2,PaCO2,OI, P/F before treatment and 2 hours after treatment between the two groups(P>0.05).Compared the data of 12h,24h,and 48h after treatment,the lavage group was better than injection group(P<0.01).The duration of mechanical ventilation in lavage group(65.2±11.8)h was less than that in injection group(78.6±13.5)h(t=6.12, P<0.01).The cure rate of lavage group 66/68 cases(97.1%) was higher than that in injection group 60/68 cases(88.2%)(χ2=3.89,P<0.05).The complication rate of lavage group 2/68 cases(2.9%) was lower than that in injection group 9/68 cases(13.2%)(χ2=4.85, P<0.05). Conclusion The clinical effect of endotracheal lavage with PS attenuant is better than intratracheal injection with PS original fluid on improving ventilation and oxygenation efficiency, and also can decrease the duration of mechanical ventilation and the complication rate,while increase the cure rate. The method ofendotracheal lavage with PS attenuant is safe, effective and worth widely using in clinical treatment.更多还原