机械通气联合肺表面活性物质对新生儿重症肺炎伴呼吸衰竭氧合功能及预后的影响
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摘要
目的观察新生儿重症肺炎伴呼吸衰竭应用机械通气与肺表面活性物质(Pulmonary surfactant,PS)治疗的效果。方法方便选取2017年1月—2018年7月该院收治的重症肺炎伴呼吸衰竭新生儿78例,采用随机数表法分为观察组(机械通气+PS,39例)与对照组(机械通气,39例)。比较两组血氧分压(Partial pressure of oxygen,PaO_2)/吸入氧分数(Fraction of inspiration O_2,FiO_2),PaO_2/FiO_2、血二氧化碳分压(Partial Pressure of Carbon Dioxide,PaCO_2)、PaO_2、乳酸值、治疗时间以及并发症发生情况。结果观察组PaO_2/FiO_2为(284.47±48.09)、PaO_2为(9.78±1.36)k Pa高于对照组的(237.91±49.26)、(7.92±1.13)k Pa,PaCO_2为(4.82±0.63)k Pa低于对照组的(5.68±0.73)k Pa,差异有统计学意义(t=4.224、6.569、5.570,P=0.000);观察组吸氧总时间为(96.62±18.07)h、机械通气为(95.47±17.40)h、住院时间为(21.29±4.58)d均短于对照组的(116.71±28.09)h、(112.57±20.19)h、(27.11±5.13)d,差异有统计学意义(t=3.756、4.007、5.285,P=0.000);观察组并发症发生率10.26%低于对照组的28.20%,差异有统计学意义(χ~2=4.044,P=0.044)。结论针对新生儿重症肺炎伴呼吸衰竭患儿,应用机械通气联合PS治疗利于增强氧合功能,优化动脉血气分析指标,改善患儿预后。
Objective To observe the effect of mechanical ventilation and pulmonary surfactant(PS)in the treatment of severe pneumonia with respiratory failure in neonates.Methods A total of 78 neonates with severe pneumonia and respiratory failure admitted to our hospital from January 2017 to July 2018 were convenient selected and enrolled.The patients were randomly divided into observation group(mechanical ventilation+PS,39 cases)and control group(mechanical ventilation,39 cases).Comparison of Partial pressure of oxygen(PaO_2)/Fraction of inspiration O_2(Fi O_2),PaO_2/FiO_2,Partial Pressure of Carbon Dioxide(PaCO_2),PaO_2,lactate value,treatment time and complications.Results PaO_2/FiO_2in the observation group was(284.47±48.09),PaO_2was(9.78±1.36)k Pa higher than that in the control group(237.91±49.26),(7.92±1.13)k Pa,and PaCO_2was(4.82±0.63)k Pa lower than the control group of(5.68±0.73)k Pa,the difference was statistically significant(t=4.224,6.569,5.570,P=0.000).The total oxygen infusion time of the observation group was(96.62±18.07)h,and the mechanical ventilation was(95.47±17.40)h,hospital stay was(21.29±4.58)d were shorter than the control group(116.71±28.09)h,(112.57±20.19)h,(27.11±5.13)d,the difference was statistically significant(t=3.756,4.007,5.285,P=0.000);the incidence of complications in the observation group was 10.26%lower than that in the control group(28.20%),and the difference was statistically significant(χ~2=4.044,P=0.044).Conclusion In the treatment of neonatal severe pneumonia with respiratory failure,the application of mechanical ventilation combined with PS treatment is beneficial to enhance oxygenation,optimize arterial blood gas analysis indicators,and improve the prognosis of children.
Objective To observe the effect of mechanical ventilation and pulmonary surfactant(PS)in the treatment of severe pneumonia with respiratory failure in neonates.Methods A total of 78 neonates with severe pneumonia and respiratory failure admitted to our hospital from January 2017 to July 2018 were convenient selected and enrolled.The patients were randomly divided into observation group(mechanical ventilation+PS,39 cases)and control group(mechanical ventilation,39 cases).Comparison of Partial pressure of oxygen(PaO_2)/Fraction of inspiration O_2(Fi O_2),PaO_2/FiO_2,Partial Pressure of Carbon Dioxide(PaCO_2),PaO_2,lactate value,treatment time and complications.Results PaO_2/FiO_2in the observation group was(284.47±48.09),PaO_2was(9.78±1.36)k Pa higher than that in the control group(237.91±49.26),(7.92±1.13)k Pa,and PaCO_2was(4.82±0.63)k Pa lower than the control group of(5.68±0.73)k Pa,the difference was statistically significant(t=4.224,6.569,5.570,P=0.000).The total oxygen infusion time of the observation group was(96.62±18.07)h,and the mechanical ventilation was(95.47±17.40)h,hospital stay was(21.29±4.58)d were shorter than the control group(116.71±28.09)h,(112.57±20.19)h,(27.11±5.13)d,the difference was statistically significant(t=3.756,4.007,5.285,P=0.000);the incidence of complications in the observation group was 10.26%lower than that in the control group(28.20%),and the difference was statistically significant(χ~2=4.044,P=0.044).Conclusion In the treatment of neonatal severe pneumonia with respiratory failure,the application of mechanical ventilation combined with PS treatment is beneficial to enhance oxygenation,optimize arterial blood gas analysis indicators,and improve the prognosis of children.
引文
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[2]刘莉,吕蓉蓉,陈光耀,等.肺表面活性物质联合HFO对新生儿呼吸衰竭的疗效及对血清CK-MB、ET-1、Cys-C的影响[J].国际呼吸杂志,2018,38(13):996-1000.
[3]劳庆禄.肺泡表面活性物质辅助机械通气治疗新生儿呼吸窘迫综合征的疗效及对血液指标的影响[J].海南医学院学报,2015,21(6):781-784.
[4]江载芳,申昆玲,沈莹.诸福棠实用儿科学[M].北京:人民卫生出版社,2015.
[5]罗庆容,沈俊妃.危重症新生患儿血清乳酸水平和血小板计数变化及意义[J].山东医药,2015,55(24):87-88.
[6]吴景莲.机械通气联合肺表面活性物质治疗新生儿重症肺炎合并呼吸衰竭疗效观察[J].儿科药学杂志,2016,22(10)18-21.
[7]何艺.新生儿肺泡表面活性物质蛋白A基因多态性与肺炎易感性、炎症反应程度的相关性[J].海南医学院学报,2017,23(12):1668-1671.
[8]张三红.两种剂量牛肺表面活性物质对呼吸窘迫综合征近足月早产儿患儿血气分析指标、机械通气时间及并发症的影响[J].广西医科大学学报,2016,33(6):1034-1036.