肺表面活性物质对新生儿呼吸窘迫综合征的临床疗效研究

目的 探讨肺表面活性物质(PS)对新生儿呼吸窘迫综合征(NRDS)的临床疗效.方法 将39例NRDS患儿分两组,治疗组19例给予PS联合机械通气治疗,对照组20例单纯机械通气治疗,其余治疗两组相同.观察应用PS前后血气分析、呼吸机参数变化及比较两组患儿机械通气时间、并发症、住院时间、病死率.结果 应用PS后动脉氧分压(PaO2)升高(P＜0.01),二氧化碳分压(PaCO2)、吸气峰压(PIP)、平均气道压(PEEP)及吸入氧浓度(FiO2)下降(P＜0.01);两组机械通气时间、住院天数、并发症等差异均有统计学意义(P＜0.05),病死率差异无统计学意义(P＞0.05).结论 PS对NRDS有明显疗效,与单纯机械通气比较,能改善患儿的氧合,减少机械通气时间、并发症和住院天数.     

肺表面活性物质对呼吸窘迫综合征高危患儿的预防作用

新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS）为新生儿死亡的主要原因,病死率占7天内死亡的首位。表面活性物质（PS）缺乏是新生儿发生NRDS的主要原因,PS替代治疗是针对NRDS的病因治疗,1980年Fuijiwar等首先应用从牛肺中提取的表面活性物质治疗重症新生儿呼吸窘迫综合征并取得了良好效果,近几年许多国外学者强调早期预防性用药,可以减少NRDS的发生及减轻其严重程度,我科近年也开展了PS的早期预防性应用,取得了良好效果,现报道如下。     

肺表面活性物质治疗足月新生儿急性呼吸窘迫综合征疗效分析

目的探讨肺表面活性物质治疗足月新生儿急性呼吸窘迫综合征的临床疗效。方法选择该院2015-02~2016-04收治的74例足月新生儿急性呼吸窘迫综合征患儿为研究对象,按随机数字表法分为观察组和对照组各37例。对照组接受常规疗法,观察组在对照组基础上加用肺表面活性物质治疗。对两组患儿疗效及治疗前与治疗后24 h血气指标进行观察比较。结果观察组显效15例,有效20例,无效2例。对照组显效9例,有效19例,无效9例。观察组疗效优于对照组(P0.05)。治疗前,两组患者血气分析指标无明显差异(P0.05),治疗后观察组血氧分压(Pa O2)、二氧化碳分压(Pa CO2)、p H值均优于对照组,差异有统计学意义(P0.01)。结论肺表面活性物质应用于足月新生儿急性呼吸窘迫综合征治疗中效果显著,能快速改善血气指标,值得临床推广。     

新生儿呼吸窘迫综合征早期应用肺表面活性物质治疗的观察

目的探讨肺表面活性物质对新生儿呼吸窘迫综合征(NRDS)的治疗效果。方法将100例NRDS患儿随机分为治疗组50例和对照组50例,两组均给予机械通气等常规治疗,治疗组在此基础上给予气管内滴入肺表面活性物质,剂量为100 mg/kg。结果治疗组存活率高于对照组,(P<0.05);治疗组通气时间明显低于对照组(P<0.05);治疗组治疗后血气分析与对照组同项比较,(P均<0.05或<0.01);治疗组治疗后各时段机械通气参数FiO2、VEI、MAP与对照组同项比较,(P均<0.05或<0.01)。结论肺表面活性物质对NRDS疗效满意,值得推广。     

肺表面活性物质治疗新生儿呼吸窘迫综合征疗效分析

目的探讨肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效。方法将60例新生儿呼吸窘迫征患儿随机分为观察组和对照组,每组各30例,对照组给予保暖、吸痰、吸氧、控制感染、防治出血、机械通气等常规治疗,观察组在常规治疗的基础上应用肺表面活性物质治疗,观察两组患儿的发生率。结果观察组新生儿呼吸窘迫综合征的发生率低于对照组,差异有统计学意义（P〈0.05）。结论肺表面活性物质治疗新生儿呼吸窘迫综合征患儿疗效显著,有显著的预防作用并可以减轻病情。     

肺表面活性物质治疗糖尿病孕妇新生儿呼吸窘迫综合征的临床疗效探讨

目的探究肺表面活性物质治疗糖尿病孕妇新生儿呼吸窘迫综合征的临床治疗效果。方法选取2014年3月—2015年10月在该院进行治疗的50例由糖尿病孕妇所娩出的呼吸窘迫综合征新生儿,将所有患儿随机分为对照组和研究组,每组各25例。对对照组患儿进行基础性的综合治疗,而对研究组患儿在采取基础治疗与肺表面活性物质联合应用治疗的方法,对两组患儿在治疗后的临床效果包括临床治愈率、机械通气时间、住院时间、不良反应发生情况以及住院所花费用等进行比较分析。结果两组患儿经过治疗后,研究组患儿的总有效率(96%)明显高于对照组患儿的总有效率(64%),研究组并发症的发生率(4%)明显低于对照组并发症的发生率(20%),差异有统计学意义(P0.05);而研究组患儿的机械通气、用氧以及住院时均比对照组患儿低,差异有统计学意义(P0.05)。结论采用肺表面活性物质治疗新生儿呼吸窘迫综合征,尤其是由糖尿病孕妇娩出的新生儿,具有显著的治疗效果,而且安全性高,可以明显缩短患儿的治疗住院时间,对改善呼吸窘迫综合征患儿的生存质量以及肺部功能具有十分重要的作用,值得在临床广泛推广。     

新生儿呼吸窘迫综合征肺表面活性物质替代疗法的护理

新生儿呼吸窘迫综合征（NRDS）是新生儿常见危重疾病之一，多发生于早产儿。由于肺发育不成熟，先天缺乏肺表面活性物质（PS），更易造成严重呼吸衰竭，而且可以带来长期的呼吸和精神系统的后遗症。运用肺表面活性物质替代疗法是治疗NRDS的有效方法。2003年8月～2006年12月我院NICU对27例NRDS患儿，运用PS实施综合救治和护理，取得了满意的临床疗效，现报道如下。     

氨溴索、肺表面活性物质预防新生儿呼吸窘迫综合征分析

目的比较应用氨溴索和肺表面活性物质两种方法在预防新生儿呼吸窘迫综合征中的效果。方法将我院138例早产儿随机分成A、B、C三组,分别采用氨溴索、肺表面活性物质以及不做药物预防措施,每组各46例,比较三组患儿的呼吸窘迫综合征发生率、发病时间、并发症发生例数等。结果采用了预防措施的A、B组患儿发生新生儿呼吸窘迫综合征的几率明显降低,发病时间也显著延后,并发症也较少,与C组患儿比较有统计学意义(P<0.05)。A、B两组间对比,无统计学意义(P>0.05)。结论氨溴索和肺表面活性物质对预防新生儿呼吸窘迫综合征都有很好的效果,由于氨溴索使用方便、效果明显、价格较低,适合在基层医院大量推广使用,但肺表面活性物质由于作用直接,见效比氨溴索快,在病情较急和患者家庭经济条件允许时可选择性使用。     

不同通气方式联合肺表面活性物质治疗新生儿呼吸窘迫综合征疗效评价

目的探讨两种不同通气方式联合肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征（NRDS）的疗效及安全性。方法将40例NRDS患儿随机分为两组,观察组给予鼻塞持续气道正压通气（NCPAP）联合PS,对照组给予常规机械通气（CMV）联合PS,比较两组的疗效、用机时间、氧疗时间、住院时间、住院费用及肺部并发症。结果两组治疗成功率、用机时间比较无统计学差异;观察组的氧疗时间、住院费用、肺部感染并发症的发生率均明显低于对照组（P〈0．05或〈0．01）。结论NCPAP联合PS的疗效与CMV联合PS相似,而前者能减少肺部感染等并发症,缩短氧疗时间和住院时间,降低住院费用,值得临床推广应用。     

肺表面活性物质联合高频震荡通气对新生儿呼吸窘迫综合征的临床疗效

目的：研究肺表面活性物质联合高频震荡通气对新生儿呼吸窘迫综合征的临床疗效。方法选择2012年1月至2016年3月在我院进行诊治的新生儿呼吸窘迫综合征患者82例,分为常频机械通气组(n =41)和高频震荡通气组(n =41)。常频机械通气组采用肺表面活性物质联合常频机械通气治疗,高频震荡通气组采用肺表面活性物质联合高频震荡通气治疗。比较2组患儿治疗前、后的临床症状、血气分析、治愈率、上机时间、住院时间和并发症发生情况。结果治疗前,2组PaCO 2、PaO 2、吸入氧浓度和氧合指数差异无统计学意义(P 值均>0.05),治疗后1、6、12、24 h高频震荡通气组 PaO 2明显高于常频机械通气组(P 值均<0.05),PaCO 2、吸入氧浓度和氧合指数明显低于常频机械通气组(P 值均<0.05);高频震荡通气组住院时间、上机时间和死亡率均明显低于常频机械通气组(P 值均<0.05);2组患儿最主要的并发症为新生儿硬肿症和肺炎,2组的并发症发生率差异无统计学意义(P 值均>0.05)。结论肺表面活性物质联合高频震荡通气能明显改善新生儿呼吸窘迫综合征患儿的血气分析和氧合指数,缩短机械通气治疗时间及住院时间,值得应用推广。     

固尔苏在预防新生儿呼吸窘迫综合征的临床效果观察

目的探讨固尔苏在预防新生儿(胎龄<32周)呼吸窘迫综合征的临床效果。方法对本院2011年3月至2011年12月的"胎龄<32周"新生儿60例进行回顾分析,随机分为对照组和固尔苏组,两组均给予NCPAP,且仅有固尔苏组气管插管给予固尔苏处理;观察两组的Apgar评分、血气分析情况、呼吸窘迫综合征的发生率。结果 (1)固尔苏组的Apgar评分(P<0.05)、血PaO2(P<0.01)、血pH(P<0.05)高于对照组,且血PaCO2(P<0.05)低于对照组;(2)对照组共出现12例NRDS患者,固尔苏组仅出现3例,具有统计学差异(P<0.01)。结论给予"胎龄<32周"新生儿预防量的固尔苏处理可有效的预防呼吸窘迫综合征的发生,同时可改善血气指标和Apgar评分,可在新生儿呼吸窘迫综合征的预防中进行推广。     

早期联合应用NCPAP和PS治疗新生儿呼吸窘迫综合征

目的讨论经鼻持续气道正压通气(NCPAP)联合肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的治疗效果。方法应用NCPAP联合PS治疗25例呼吸窘迫综合征的新生儿,并对其临床特点、动脉血气分析进行分析。结果 23例发绀和呼吸困难症状均有所减轻或消失。X线表现肺透亮度明显改善,或病变未进展,血气分析参数明显改善。2例因病情加重放弃治疗。结论 NCPAP联合PS能迅速有效地治疗新生儿呼吸窘迫综合征。用这种方法通过阻止呼吸窘迫综合征的进展,降低了以后应用呼吸机的需要。细致观察和正确的护理也是治疗成功的关键。     

Pathophysiology of Neonatal Respiratory Distress Syndrome

Neonatal respiratory distress syndrome (RDS) remains one of the major causes of neonatal mortality and morbidity despite advances in perinatal care. The initial management of infants with RDS has almost become 'too routine' with little thought about the pathophysiological processes that lead to the disease and how the clinician can use the existing therapeutic interventions to optimize care. The transition from fetus to infant involves many complex adaptations at birth; the most important is the function of the lungs as a gas exchange organ. Preterm surfactant-deficient infants are less well equipped to deal with this transition. Optimum gas exchange is achieved through matching of ventilation and perfusion. In RDS, ventilation may be affected by homogeneity of the airways with atelectasis and over distension, as hyaline membranes block small airways. In turn this contributes to the inflammation that becomes bronchopulmonary dysplasia. Exogenous surfactant given early, particularly with positive end-expiratory pressure and, where necessary, gentle ventilation, would seem to be the optimum way to prevent atelectasis. How this can be achieved in neonates after surfactant therapy is explored through a review of the normal physiology of the newborn lung and how this is affected by RDS. The therapeutic interventions of resuscitation, exogenous surfactant, ventilation and inhaled nitric oxide are discussed in relation to their effects and what are currently the optimum ways to use these. It is hoped that with a better understanding of the normal physiology in the newborn lung, and the effects of both disease and interventions on that physiology, the practising clinician will have a greater appreciation of management of preterm infants with, or at risk of, RDS.     

Surfactant Therapy for Respiratory Distress Syndrome in Premature Neonates

Exogenous surfactant therapy has been part of the routine care of preterm neonates with respiratory distress syndrome (RDS) since the beginning of the 1990s. Discoveries that led to its development as a therapeutic agent span the whole of the 20th century but it was not until 1980 that the first successful use of exogenous surfactant therapy in a human population was reported. Since then, randomized controlled studies demonstrated that surfactant therapy was not only well tolerated but that it significantly reduced both neonatal mortality and pulmonary air leaks; importantly, those surviving neonates were not at greater risk of subsequent neurological impairment.Surfactants may be of animal or synthetic origin. Both types of surfactants have been extensively studied in animal models and in clinical trials to determine the optimum timing, dose size and frequency, route and method of administration. The advantages of one type of surfactant over another are discussed in relation to biophysical properties, animal studies and results of randomized trials in neonatal populations. Animal-derived exogenous surfactants are the treatment of choice at the present time with relatively few adverse effects related largely to changes in oxygenation and heart rate during surfactant administration. The optimum dose of surfactant is usually 100 mg/kg.The use of surfactant with high frequency oscillation and continuous positive pressure modes of respiratory support presents different problems compared with its use with conventional ventilation.The different components of surfactant have important functions that influence its effectiveness both in the primary function of the reduction of surface tension and also in secondary, but nonetheless just as important, role of lung defense. With greater understanding of the individual surfactant components, particularly the surfactant-associated proteins, development of newer synthetic surfactants has been made possible.Despite being an effective therapy for RDS, surfactant has failed to have a significant impact on the incidence of chronic lung disease in survivors. Paradoxically the cost of care has increased as surviving neonates are more immature and consume a greater proportion of neonatal intensive care resources. Despite this, surfactant is considered a cost-effective therapy for RDS compared with other therapeutic interventions in premature infants.     

Surfactant Treatment for Congenital Heart Disease Patients with Acute Respiratory Distress Syndrome

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) can be a significant source of morbidity for pediatric cardiac patients in the intensive care unit. Children with unrepaired or palliated congenital heart disease are at increased risk for lower respiratory tract infections, while postoperatively they are at risk for ALI/ARDS precipitated by cardiopulmonary bypass. Surfactant dysfunction and inactivation are key contributors to the pathophysiology of ALI/ARDS, and there is growing evidence that exogenous intratracheal surfactant administration in noncardiac patients may ameliorate the lung injury seen in children with ALI/ARDS, leading to improved outcomes and survival. Evidence for a beneficial effect of exogenous surfactant treatment in congenital heart disease patients with ALI/ARDS is lacking. We present three consecutive children with congenital heart disease and ARDS who had significant and sustained improvement in lung function and oxygenation after treatment with exogenous surfactant, hastening their recovery from life-threatening hypoxemia.     

急性呼吸窘迫综合征的临床诊治分析

目的探究急性呼吸窘迫综合征(ARDS)的诊断和治疗方法。方法选择2006年1月—2011年1月在我院治疗的ARDS患者13例,并进行回顾性研究。结果 13例患者死亡7例,死亡率为53.8%,4例患者死于多器官功能衰竭综合征。结论 ARDS的早期诊断和治疗非常重要,一旦出现急性肺损伤征象必须积极机械通气,同时改善患者电解质状态,减少MODS的发生,降低病死率。     

体外循环后肺损伤和急性呼吸窘迫综合征

在体外循环过程中，经常伴随不同程度的肺损伤，通常用肺泡动脉氧合梯度，肺内分流量，肺水肿的程度，肺的顺应性以及肺血管的阻力来评估肺损伤的程度，并且肺损伤有可能发展成为急性呼吸窘迫综合征（ARDS），给患者生命带来危险。另一方面体外循环（CPB）介导的一系列炎性反应，包括补体，白细胞，内皮细胞的激活，同时释放各种细胞因子，蛋白水解酶和氧自由基，最后使白细胞黏附在微血管内皮上，导致组织和细胞损伤，虽然，体外循环后炎性反应仍处于一种亚临床水平，但其导致的严重后果仍需足够的重视,本文就近些年来对体外循环后肺损伤及ARDS在分子和细胞水平的研究进展作一综述。