机械通气下应用肺表面活性物质治疗 新生儿肺炎合并呼吸衰竭的疗效

Therapeutic Effect of Pulmonary Surfactant on Neonatal Pneumonia with Respiratory Failure under Mechanical Ventilation

摘要:

〔摘 要〕 目的：探讨新生儿肺炎合并呼吸衰竭治疗中机械通气下应用肺表面活性物质的疗效。 方法：回顾性选取 2017 年 2 月至 2022 年 2 月无锡市儿童医院新生儿科收治的新生儿肺炎合并呼吸衰竭患儿 80 例，依据治疗方法分为 机械通气下应用肺表面活性物质治疗组（观察组）、机械通气治疗组（对照组）两组，各 40 例。分析两组患儿血气 指标、平均动脉压（MAP）和呼吸力学指标、机械通气时间、总吸氧时间、住院时间、并发症发生情况之间的差异。 结果：治疗前，两组患儿的动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）、动脉血二氧化碳分压（PaCO2）、氢离 子浓度指数（pH）、MAP、呼气末正压（PEEP）、平台压（Pplat）、气道峰压（PIP）之间比较，差异均无统计学 意义（P ＞ 0.05）；治疗后，两组患儿的 PaO2、PaO2/FiO2 均高于治疗前，PaCO2、MAP、PEEP 均低于治疗前，差异 均具有统计学意义（P ＜ 0.05），但治疗前后的 PIP、pH、Pplat 之间的差异均无统计学意义（P ＞ 0.05），观察组患 儿的 PaO2 高于对照组，PaCO2、MAP、PEEP、PIP 均低于对照组，差异均具有统计学意义（P ＜ 0.05），但两组患 儿的 PaO2/FiO2、pH、Pplat 之间的差异均无统计学意义（P ＞ 0.05）；观察组患儿的机械通气时间、总吸氧时间、住 院时间均短于对照组，差异均具有统计学意义（P ＜ 0.05）；观察组患儿的并发症发生率为 10.00 %，与对照组患儿 相一致，差异无统计学意义（P ＞ 0.05）。 结论：新生儿肺炎合并呼吸衰竭治疗中，采用机械通气下应用肺表面活性 物质的疗效较单纯机械通气更显著。

Abstract:

〔Abstract〕 Objective To investigate the effect of pulmonary surfactant under mechanical ventilation in the treatment of neonatal pneumonia complicated with respiratory failure. Methods 80 children with neonatal pneumonia complicated with respiratory failure in the Neonatology Department of Wuxi Children's Hospital from February 2017 to February 2022 were retrospectively selected. According to the treatment method, they were divided into two groups: the treatment group (observation group) and the mechanical ventilation treatment group (control group), with 40 cases each. The differences between the two groups in blood gas index, mean arterial pressure (MAP), respiratory mechanics index, mechanical ventilation time, total oxygen uptake time, hospital stay and complications were analyzed. Results Before treatment, arterial partial oxygen pressure (PaO2), oxygenation index (PaO2/FiO2), arterial partial carbon dioxide pressure (PaCO2), hydrogen ion concentration index (pH), MAP, positive end expiratory pressure (PEEP), plateau pressure (Pplat), and peak airway pressure (PIP) were compared between the two groups, there was no statistical significance (P > 0.05). After treatment, PaO2, PaO2/FiO2 in the two groups were higher than before treatment, and PaCO2, MAP and PEEP were lower than before treatment, the differences were statistically significance (P < 0.05), but there was no statistical significance in PIP, pH and Pplat before and after treatment (P > 0.05). The PaO2 of the observation group was higher than that of the control group, and the PaCO2, MAP, PEEP and PIP were lower than those of the control group, the differences were statistically significance (P < 0.05), but there was no statistical significance in PaO2/FiO2, pH and Pplat between the two groups (P > 0.05). The mechanical ventilation time, total oxygen inhalation time and hospital stay of the observation group were shorter than those of the control group, the differences were statistically significance (P < 0.05). The incidence of complications in the observation group was 10.00 %, which was consistent with that in the control group, there was no statistical significance (P > 0.05). Conclusion In the treatment of neonatal pneumonia with respiratory failure, the effect of using pulmonary surfactant under mechanical ventilation is more significant than that of mechanical ventilation alone.