机械通气联合不同肺表面活性物质在新生儿呼吸窘迫综合征中的价值
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摘要
目的探讨机械通气联合不同的肺表面活性物质在治疗新生儿呼吸窘迫综合征(NRDS)中的临床价值。方法连续性纳入自2016年3月至2017年3月内蒙古医科大学附属医院新生儿监护室所收治的NRDS病人共72例,均给予持续气道内正压通气(CPAP)联合肺表面活性物质治疗。据病儿家庭经济条件及家长意见病儿分别接受猪肺磷脂注射液(40例)和注射用牛肺表面活性剂(32例)治疗,比较两组病儿临床治疗结果和并发症等情况。结果肺表面活性物质治疗后两组病儿血气指标均较治疗前明显改善(均P<0.05)。猪肺磷脂注射液组在用药后第4小时及第24小时血气氧分压[p(O_2)]分别为(78.39±12.34)、(85.61±9.46) mmHg,显著性高于注射用牛肺表面活性剂组,差异有统计学意义(t_(4 h)=2.079,P_(4 h)=0.041;t_(24 h)=2.257,P_(24 h)=0.027);猪肺磷脂注射液组第24小时血气二氧化碳分压[p(CO_2)]为(38.16±11.72)mmHg,显著低于注射用牛肺表面活性剂组(t=2.193,P=0.031)。猪肺磷脂注射液组给药时间为(4.73±1.67) min(t=13.142,P<0.001),持续气道内正压通气(CPAP)时间为(96.34±22.17) h(t=3.227,P=0.002),均显著性低于注射用牛肺表面活性剂组,但两组重复给药比例及住院时间、并发症发生率、病死率均差异无统计学意义(均P>0.05)。结论猪肺磷脂注射液应用方便,可更加有效地改善病儿血气指标,缩短CPAP时间,且不增加病儿治疗风险。
Objective To investigate the differences of clinical value of different pulmonary surfactant combined with mechanical ventilation in neonatal respiratory distress syndrome(NRDS).Methods Seventy-two cases of NRDS patients admitted to Department of Critical Care Medicine,Affiliated Hospital of Inner Mongolia Medical University from March 2016 to March 2017 were enrolled.Both groups were treated with the continuous airway pressure ventilation(CPAP) combined pulmonary surfactant.According to the decisions of parents and their family financial conditions,patients took Porcine pulmonary phospholipid injection(40 cases) or Bovine pulmonary surfactant for injection(32 cases).The clinical value and complications were compared between two groups.Results Indexes of blood gas in both groups were significantly ameliorated after pulmonary surfactant therapy(all P<0.05).p(O_2) of 4 h [(78.39±12.34) mmHg,t=2.079,P=0.041] and 24 h [(85.61±9.46) mmHg, t=2.256,P=0.027] in Porcine pulmonary phospholipid injection group were significantly higher than those in Bovine pulmonary surfactant for injection group,and p(CO_2) of 24 h [(38.16±11.72) mmHg, t=2.193,P=0.031] in Porcine pulmonary phospholipid injection group was significantly lower than that in Bovine pulmonary surfactant for injection group.The dosing time [(4.73±1.67) min,t=13.142,P<0.001] and CPAP time [(96.34±22.17) h,t=3.227,P=0.002] in Porcine pulmonary phospholipid injection group were significantly lower than those in Bovine pulmonary surfactant for injection group,but the dose repeated ratio,length of hospital stay,the complication rate and the mortality rate between the two groups had no staistical difference(all P>0.05).Conclusion Porcine pulmonary phospholipid injection was more convenient to use,and could better improve the blood gas indexes with shorter CPAP time and did not increase the risk.
Objective To investigate the differences of clinical value of different pulmonary surfactant combined with mechanical ventilation in neonatal respiratory distress syndrome(NRDS).Methods Seventy-two cases of NRDS patients admitted to Department of Critical Care Medicine,Affiliated Hospital of Inner Mongolia Medical University from March 2016 to March 2017 were enrolled.Both groups were treated with the continuous airway pressure ventilation(CPAP) combined pulmonary surfactant.According to the decisions of parents and their family financial conditions,patients took Porcine pulmonary phospholipid injection(40 cases) or Bovine pulmonary surfactant for injection(32 cases).The clinical value and complications were compared between two groups.Results Indexes of blood gas in both groups were significantly ameliorated after pulmonary surfactant therapy(all P<0.05).p(O_2) of 4 h [(78.39±12.34) mmHg,t=2.079,P=0.041] and 24 h [(85.61±9.46) mmHg, t=2.256,P=0.027] in Porcine pulmonary phospholipid injection group were significantly higher than those in Bovine pulmonary surfactant for injection group,and p(CO_2) of 24 h [(38.16±11.72) mmHg, t=2.193,P=0.031] in Porcine pulmonary phospholipid injection group was significantly lower than that in Bovine pulmonary surfactant for injection group.The dosing time [(4.73±1.67) min,t=13.142,P<0.001] and CPAP time [(96.34±22.17) h,t=3.227,P=0.002] in Porcine pulmonary phospholipid injection group were significantly lower than those in Bovine pulmonary surfactant for injection group,but the dose repeated ratio,length of hospital stay,the complication rate and the mortality rate between the two groups had no staistical difference(all P>0.05).Conclusion Porcine pulmonary phospholipid injection was more convenient to use,and could better improve the blood gas indexes with shorter CPAP time and did not increase the risk.
引文
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[14] 康文清,孙慧清,陈宇辉,等.不同时间给予肺表面活性物质治疗对呼吸窘迫综合征早产儿的影响[J].中国新生儿科杂志,2012,27(1):32-35.
[15] ZHANG L,CAO HY,ZHAO S,et al.Effect of exogenous pulmonary surfactants on mortality rate in neonatal respiratory distress syndrome:a network meta-analysis of randomized controlled trials[J].Pulm Pharmacol Ther,2015,34:46-54.
[16] 赵冰,潘家华.不同肺表面活性物质治疗新生儿呼吸窘迫综合征疗效比较[J].中国新生儿科杂志,2014,29(3):158-161.
[17] 刘春枝,梅花.不同肺表面活性物质对新生儿呼吸窘迫综合征患儿影响的对比研究[J].实用心脑肺血管病杂志,2016,24(7):61-63,69.
[2] SAKONIDOU S,DHALIWAL J.The management of neonatal respiratory distress syndrome in preterm infants (European Consensus Guidelines:2013 update)[J].Arch Dis Child Educ Pract Ed,2015,100(5):257-259.
[3] TOCHIE JN,CHOUKEM SP,LANGMIA RN,et al.Neonatal respiratory distress in a reference neonatal unit in Cameroon:an analysis of prevalence,predictors,etiologies and outcomes[J].Pan Afr Med J,2016,24:152.
[4] CONDó V,CIPRIANI S,COLNAGHI M,et al.Neonatal respiratory distress syndrome:are risk factors the same in preterm and term infants?[J].J Matern Fetal Neonatal Med,2017,30(11):1267-1272.
[5] PRAMANIK AK,RANGASWAMY N,GATES T.Neonatal respiratory distress:a practical approach to its diagnosis and management[J].Pediatr Clin North Am,2015,62(2):453-469.
[6] YUE TT,XU Y,LI SX,et al.Lipid extraction mediates aggregation of carbon nanospheres in pulmonary surfactant monolayers[J].Phys Chem Chem Phys,2016,18(28):18923-18933.
[7] THEODOROU IG,RUENRAROENGSAK P,GOW A,et al.Effect of pulmonary surfactant on the dissolution,stability and uptake of zinc oxide nanowires by human respiratory epithelial cells[J].Nanotoxicology,2016,10(9):1351-1362.
[8] NAKAHARA H.Fluidizing and solidifying effects of perfluorooctylated fatty alcohols on pulmonary surfactant monolayers[J].J Oleo Sci,2016,65(2):99-109.
[9] SU XY,LI ZF,WANG ML,et al.The protective effect of different airway humidification liquids to lung after tracheotomy in traumatic brain injury:the role of pulmonary surfactant protein-A (SP-A)[J].Gene,2016,577(1):89-95.
[10] RUGE CA,HILLAIREAU H,GRABOWSKI N,et al.Pulmonary surfactant protein A-mediated enrichment of surface-decorated polymeric nanoparticles in alveolar macrophages[J].Mol Pharm,2016,13(12):4168-4178.
[11] LOPEZ-RODRIGUEZ E,PASCUAL A,ARROYO R,et al.Human pulmonary surfactant protein SP-A1 provides maximal efficiency of lung interfacial films[J].Biophys J,2016,111(3):524-536.
[12] YANG HY,LI H,WANG YG,et al.Correlation analysis between single nucleotide polymorphisms of pulmonary surfactant protein a gene and pulmonary tuberculosis in the han population in China[J].Int J Infect Dis,2014,26:31-36.
[13] GUILLAMAT-PRATS R,GAY-JORDI G,XAUBET A,et al.Alveolar type II cell transplantation restores pulmonary surfactant protein levels in lung fibrosis[J].J Heart Lung Transplant,2014,33(7):758-765.
[14] 康文清,孙慧清,陈宇辉,等.不同时间给予肺表面活性物质治疗对呼吸窘迫综合征早产儿的影响[J].中国新生儿科杂志,2012,27(1):32-35.
[15] ZHANG L,CAO HY,ZHAO S,et al.Effect of exogenous pulmonary surfactants on mortality rate in neonatal respiratory distress syndrome:a network meta-analysis of randomized controlled trials[J].Pulm Pharmacol Ther,2015,34:46-54.
[16] 赵冰,潘家华.不同肺表面活性物质治疗新生儿呼吸窘迫综合征疗效比较[J].中国新生儿科杂志,2014,29(3):158-161.
[17] 刘春枝,梅花.不同肺表面活性物质对新生儿呼吸窘迫综合征患儿影响的对比研究[J].实用心脑肺血管病杂志,2016,24(7):61-63,69.