标题：肺泡表面活性物质辅助机械通气疗法治疗新生儿呼吸窘迫综合征效果观察

      作者：陆红武，王文静，胡林林    东莞市茶山医院儿科，广东 东莞 523380

      卷次： 2022年33卷16期

      【摘要】 目的 观察新生儿呼吸窘迫综合征(NRDS)应用肺泡表面活性物质(PS)辅助机械通气疗法的治疗效果。方法 选择2016年2月至2020年9月东莞市茶山医院收治的60例新生儿呼吸窘迫患儿为研究对象，采用随机数表法分为对照组和研究组各30例。对照组患儿在常规治疗基础上进行机械通气治疗，研究组患儿在对照组治疗方案基础上实施PS补充治疗。两组疗程均为一周。比较两组患儿治疗前、治疗24 h后的血气指标[二氧化碳分压(PaCO2)、血氧分压(PaO2)、动脉氢离子浓度(pH)及氧合指数水平]、呼吸功能[氧浓度分数(FiO2)、呼气末期正压(PEEP)、吸气峰压(PIP)、平均气道压(MAP)]，同时比较两组患儿用氧时间、住院时间和治疗效果。结果 两组患儿治疗前的血气指标、呼吸功能指标比较差异均无统计学意义(P>0.05)；治疗后，研究组患儿的PaO2、pH、氧合指数分别为(90.16±8.01) mmHg、7.41±0.16、(280.65±41.38) mmHg，明显高于对照组的(78.63±7.48) mmHg、7.25±0.11、(251.22±36.42) mmHg，差异均具有统计学意义(P<0.05)；治疗后，研究组患儿的FiO2、PEEP、PIP、MAP分别为(0.39±0.13)%、(5.28±0.39) cmH2O、(18.27±3.96) cmH2O、(8.04±2.74) cmH2O，明显低于对照组的(0.61±0.20)%、(5.51±0.46) cmH2O、(24.16±4.63) cmH2O、(10.94±3.15) cmH2O，差异均有统计学意义(P<0.05)；研究组患儿的用氧时间、住院时间分别为(240.37±70.53) d、(26.63±7.32) d，明显短于对照组的(280.05±81.41) d、(32.42±6.28) d，差异均有统计学意义(P<0.05)；研究组患儿的治疗总有效率为96.67%，明显高于对照组的73.33%，差异有统计学意义(P<0.05)。结论 NRDS应用PS辅助机械通气法治疗能有效改善患儿呼吸功能及血气指标，缩短康复进程，提高治疗效果。
      【关键词】 新生儿；机械通气；呼吸窘迫；肺泡表面活性物质；临床疗效
      【中图分类号】 R722.1 【文献标识码】 A 【文章编号】 1003—6350（2022）16—2120—04

Effect of pulmonary surfactant assisted mechanical ventilation in the treatment of neonatal respiratory distresssyndrome.
LU Hong-wu, WANG Wen-jing, HU Lin-lin. Department of Pediatrics, Dongguan Chashan Hospital, Dongguan523380, Guangdong, CHINA
【Abstract】 Objective To analyze the effect of pulmonary surfactant (PS) assisted mechanical ventilation in thetreatment of neonatal respiratory distress syndrome (NRDS). Methods Sixty patients of neonatal respiratory distress inDongguan Chashan Hospital from February 2016 to September 2020 were selected and randomly divided into twogroups according to random number table. Patients in the control group were treated with mechanical ventilation, andthose in the study group were treated with PS on the basis of the treatment plan of the control group, both for 1 week. Be-fore treatment and at 24 hours after treatment, blood gas index [partial pressure of carbon dioxide (PaCO2), partial pres-sure of blood oxygen (PaO2), arterial hydrogen ion concentration (pH), and oxygenation index level], respiratory func-tion [oxygen concentration fraction (FiO2), positive end expiratory pressure (PEEP), peak inspiratory pressure (PIP), meanairway pressure (MAP)], duration of oxygen use, length of hospital stay, and curative effect were observed and comparedbetween the two groups. Results There was no significant difference in blood gas index (PaCO2, PaO2, pH, oxygenationindex) and respiratory function (FiO2, PEEP, PIP, MAP) between the two groups before treatment (P>0.05). After treat-ment, PaO2, pH, oxygenation index in the study group were (90.16±8.01) mmHg, 7.41±0.16, (280.65±41.38) mmHg, re-spectively, significantly higher than (78.63±7.48) mmHg, 7.25±0.11, (251.22±36.42) mmHg in the control group (P<0.05). After treatment, FiO2, PEEP, PIP, and MAP in the study group were (0.39±0.13)%, (5.28±0.39) cmH2O, (18.27±3.96) cmH2O, and (8.04±2.74) cmH2O, respectively, significantly lower than (0.61±0.20)%, (5.51±0.46) cmH2O, (24.16±4.63) cmH2O, and (10.94±3.15) cmH2O in the control group (P<0.05). The duration of oxygen use and length of hospitalstay in the study group were (240.37±70.53) d and (26.63±7.32) d, respectively, significantly lower than (280.05±81.41) dand (32.42±6.28) d in the control group (P<0.05). The effective rate of the study group was 96.67%, significantly higherthan 73.33% of the control group (P<0.05). Conclusion The application of PS assisted mechanical ventilation in thetreatment of NRDS can effectively improve the respiratory function and blood gas index, shorten the rehabilitation pro-cess, and improve the treatment efficiency.
      【Key words】 Neonatal; Mechanical ventilation; Respiratory distress; Pulmonary surfactant; Clinical efficacy