【摘要】 目的观察大剂量盐酸氨溴索联合可变流量鼻罩持续气道正压通气治疗新生儿肺透明膜病(HMD)的效果。方法选择HMD患者126例,随机分成治疗组(B组,n=64)和对照组(A组,n=62),两组在相同综合治疗的基础上,对照组予头罩吸氧(氧流量4~6L/min),治疗组予大剂量盐酸氨溴索(商品名沐舒坦),30mg.kg-1d-1,分两次用5%葡萄糖20ml稀释后静脉滴注,并联合可变流量鼻罩持续气道正压通气(NCPAP),其参数设定为流量6~8L/min,吸入氧浓度(FiO2)0.4~0.6,压力为5~8cmH2O;观察两组患儿治疗后12h及48h的临床症状及血气变化,比较PaO2及PaCO2及PaO2/FiO2的变化。结果治疗组64例患儿中有40例经治疗12h及48h后,呼吸困难和呻吟明显减轻或消失,血PaO2升高,PaCO2下降,氧合参数明显增加,其中以胸片RDS分级Ⅰ级及Ⅱ级效果较佳,对Ⅲ级及Ⅳ级效果较差,总有效率78%;而对照组总有效率25%,两组疗效及血气、氧合指数比较均有显著性差异。结论大剂量盐酸氨溴索联合可变流量鼻罩持续气道正压通气能改善通气及氧合,对新生儿HMD有较好的疗效,尤其对胸片RDS分级Ⅰ级及Ⅱ级的患儿;早期应用可避免气管插管,减少机械通气率。更多还原

【Abstract】 Objective:To investigate the therapeutic effect of large dose Ambroxol Hydrochloride combining variant flow rate continuous positive airway by nasal mask to hyaline membrane disease of newborn(HMD).Methods:126 newborns with HMD were randomly divided into treatment group(B group ,64 cases) and control group(A group ,62 cases),on the base of the same combined therapy ,the cases in control group only underwent oxygen-absorbing by head set with the flow rate 4～6 L/min, and the cases in treatment group were given large dose Ambroxol Hydrochloride(Mucosolvan, 30 mg·kg-1/d-1 + 5%GS20ml, for two times) and variant flow rate continuous positive airway by nasal mask(NCPAP),the parameter setting flow rate 6～8L/min, FiO2 0.4～0.6,pressure 5～8cmH2O,to observe the clinical symptom and blood gas analysis after 12 hours and 48 hours and to compare the change of PaO2, PaCO2, PaO2/ FiO in the two groups.Results:The dyspnea and groan in 40 cases in the treatment group lessoned or vanished , PaO2 raised and PaCO2 lowered, the oxygenation index obviously increased ,the cases with RDS grade Ⅰand gradeⅡ had better therapeutic effect, and the cases with RDS grade Ⅲ (X-ray)and Ⅳ had not manifest effect, the total effective rate was 78% in treatment group and 25% in control group, there were significant different in therapeutic effect and oxygenation index between the two groups.Conclusion:Large dose Ambroxol Hydrochloride combining variant flow rate continuous positive airway by nasal mask can significantly improve the ventilation and oxygenation function and there are significant therapeutic effect in HMD, especial in the HMD with RDS grade Ⅰand gradeⅡ, the trachea cannula may be avoided and mechanical ventilation rate may be decreased if the therapeutic method can be used in the earlier period.更多还原