经鼻持续气道正压通气联合肺泡表面活性物质与大剂量盐酸氨溴索防治新生儿肺透明膜病的疗效观察

目的 探讨经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)联合肺泡表面活性物质(pulmonary surfactant,PS)与静脉滴注大剂量盐酸氨溴索治疗新生儿肺透明膜病(hyaline membrane disease,HMD)的疗效.方法 选取2007年9月至2010年3月在本院确诊的新生儿肺透明膜病患儿68例为研究对象.随机将其分为治疗组(n=34)和对照组(n=34).两组患儿除常规综合治疗方案相同外,治疗组使用肺泡表面活性物质(100 mg/kg,气管内滴入)+经鼻持续气道正压通气+大剂量盐酸氨溴索[30 mg/(kg·d),分4次配10%葡萄糖盐水(glucose and saline,GS)10 mL静脉滴注];对照组仅使用肺泡表面活性物质(100 mg/kg,气管内滴入)+经鼻持续气道正压通气.观察两组患儿治疗前、后临床表现和经鼻持续气道正压通气机参数变化,X射线摄片、血气分析及经皮血氧饱和度(transcutaneous oxygen saturation,TcSO2)结果,并发症发生率和后遗症及住院时间(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署I临床研究知情同意书).两组患儿一般情况,如性别、胎龄、分娩方式、Apgar评分、出生体重、发病时间及胸部X射线分级等比较,差异无显著意义(P＞0.05).结果 治疗组临床表现、体征、X射线摄片结果、经鼻持续气道正压通气参数、血气指标及经皮血氧饱和度、并发症和后遗症发生率及住院时间与对照组比较,差异均有显著意义(P＜0.05).结论 经鼻持续气道正压通气联合肺表面活性物质与静脉滴注大剂量盐酸氨溴索治疗新生儿肺透明膜病疗效显著,可缩短机械通气时间,减少肺表面活性物质重复应用,降低并发症和后遗症的发生率,减轻患儿家庭经济负担等.

Curative Effect Observation of Nasal Continuous Positive Airway Pressure Combining Pulmonary Surfactant and Large Dose of Ambroxoi Hydrochloride to Treat Neonatal Hyaline Membrane Disease

Objective To explore the efficacy of nasal continuous positive airway pressure(NCPAP)combined with pulmonary surfactant(PS)and intravenous drip large dose of ambroxol hydrochloride to treat neonatal hyaline membrane disease(HMD).Methods From September 2007 to March 2010,68 neonates with neonatal hyaline membrane disease were enrolled in this study.They were randomly divided into treatment group(n=34)and control group(n=34)on the base of same combined therapy between two groups.Treatment group used nasal con...