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月河南省平顶山市妇幼保健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组各16例,4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,给药时采用复苏囊加压通气,给药完毕后继续给予呼吸机辅助通气。观察记录4组患儿治疗前后不同时间点的血气分析、Pa O2/Fi O2、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,4组患儿的转归情况比较差异无统计学意义(P>0.05)。4组患儿治疗前(0 h)p H、Pa O2、Pa CO2、Pa O2/Fi O2、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3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为(93.6±41.2)h,平均住院时间为(15.8±5.1)d,均短于其余3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。
Objective： To observe the clinical therapeutic method of severe meconium aspiration syndrome（ MAS）. Methods： Sixty four infants with severe MAS during September 2004 to December 2014 were randomly chosen according to four groups,each group had16 cases,including high frequency oscillation ventilation（ HFOV） ＋ pulmonary surfactant（ PS） group,conventional mechanical ventilation（ CMV） ＋ PS group,HFOV group,CMV group. All infants were given the same basic treatment. PS（ 100 mg / kg） were intratracheal to administrate after tracheal intubation,children in supine,left lateral,right lateral position injected 1 / 4 of the total dose respectively,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,Pa O2,Pa O2/ Fi O2,OI,the duration of mechanical ventilation,length of hospital stay and outcomes were observed. Results： Two cases died in HFOV ＋ PS group,3 cases died in CMV＋PS group,3 cases died in HFOV group,4 cases died in CMV group,other children were cured. There were no significant difference in outcomes of the four groups（ P〉0.05）. Before treatment,there were no statistical difference of blood gas analysis,Pa O2,Pa O2/ Fi O2 and OI among the four groups. After treatment,points of blood gas analysis at different time,Pa O2,Pa O2/Fi O2,and OI of the four groups were improved gradually over time. Concrete data in the HFOV ＋ PS group started to significantly improved. After treatment for 2 hours,12 hours,24 hours,48 hours,there were significant difference of the points of blood gas analysis,Pa O2,Pa O2/ Fi O2,and OI at different time 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 differences were statistically significant（ P〈0.05） with the other thr
出处
《儿科药学杂志》
CAS
2016年第2期24-27,共4页
Journal of Pediatric Pharmacy
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
severe
meconium aspiration syndrome
high frequency oscillatory ventilation
calf pulmonary surfactant for injection
