应用改良方法气管内滴入肺表面活性物质治疗新生儿肺透明膜病的疗效观察

目的：观察改良方法气管内滴入肺表面活性物质（pulmonary surfactant,PS）治疗新生儿肺透明膜病（Neonatal Hyaline Membrane Disease,HMD）的疗效。方法：选取96例新生儿肺透明膜病患儿,按随机数字表法分为治疗组（n=48）和对照组（n=48）,对照组采用传统的多体位间断非密闭式气管内滴入PS;治疗组应用经头皮针气管导管侧壁刺入持续气管内滴入PS,观察比较两组的各观察指标及临床转归情况。结果：治疗组的平均操作时间明显少于对照组,差异有统计学意义（P〈0.05）;且滴药过程中脱管率、管口溢药率、脉搏氧饱和度下降率及呼吸机相关性肺炎（VAP）发病率均明显低于对照组,差异均有统计学意义（P〈0.05）。结论：应用改良方法即经头皮针气管导管侧壁刺入持续气管内滴入PS成功率高,操作简单、快速,注药过程平缓,减少了脱管、药液喷出浪费、一过性缺氧及VAP的发生,是一种更快捷、方便、安全、经济、有效的给药方法,值得推广。

Observation of Curative Effect of Improved Intratracheal Injection Method of Pulmonary Surfactants inTreatment of HMD

Objective： To evaluate the efficacy of improved intratracheal injection method of pulmonary surfactants in treatment of neonatal pulmonary hyaline membrane disease（HMD）. Method： 96 newborn with HMD were divided into the treatment group（n=48）and the control group（n=48）according to random number table method. The control group was given pulmonary surfactants via traditional, multi-position, intermittently,open intracheal instillation and those in the treatment group was given pulmonary surfactants continuously via the scalp needle piercing into the side wall of endotracheal tube.The observed indexes and clinical outcomes of the two groups were observed and compared. Result： The average operation time of the treatment group was significantly shorter than the control group（P〈0.05）. The incidences of tube escaping, drug out spurting, pulse oxygen desaturation during the dosing process and ventilator associated pneumonia（VAP） of the treatment group were significantly lower than the control group（P〈0.05）. Conclusion： The application of improved method of pulmonary surfactants intratracheal injection through the scalp needle piercing into the endotracheal tube has a high success rate that the operation is simple, rapid and smoothly administrated, it also can reduce the incidences of tube escaping,drug ejecting waste, transient hypoxia and the occurrence of VAP. So it is a more quick, convenient, safe, economic and effective method and thus worthy of promotion.