肺表面活性物质治疗足月新生儿肺出血的临床研究

目的 评价PS在足月新生儿肺出血中的治疗作用。方法 40例肺出血足月新生儿，随机分为组PS组（机械通气＋气管内滴注血凝酶和PS）和对照组（机械通气＋气管内滴注血凝酶），每组20例，机械通气12 h，行血气分析，同时记录呼吸机的相关参数（RR、Vte、PIP、Pmean、Crs）；治愈新生儿肺出血停止平均时间 和撤离呼吸机时间及病死率。结果 PS组治愈18例，死亡2例；对照组治愈17例，死亡3例，病死率（10% vs 15%）较相近（P﹥0.05）；PS组肺出血停止和辅助通气时间较对照组明显缩短（43.78±8.14 vs 50.65±7.77,70.56±6.92 vs 76.06±7.29,h）（P﹤0.05）；呼吸力学指标PS组PIP和 Pmean 低于对照组（27.72±1.41 vs 28.12±1.27，24.50±1.54 vs 26.06±1.25 , cmH2O）（P﹤0.05），Crs高于对照组（0.85±0.13 vs 0.76±0.09, ml/cmH2O）（P﹤0.05）， RR和Vte两组间比较无明显变化（P﹥0.05）；两组氧动力学指标PaO2 、SaO2比较变化相近（P﹥0.05），PS组PaO2/ Fi O2高于对照组（234.11±30.14 vs 215.88±14.30）（P﹤0.05）。结论 外源性 PS主要通过改善氧合及呼吸力学效应等机制，有效防治足月新生儿肺出血。

Therapeutic effects of pulmonary surfactant in full term infant with pulmonary hemorrhage

AIM： To evaluate the efficacy and safety of the exogenous pulmonary surfactants （PS） in the treatment of full term neonates with pulmonary hemorrhage. METHODS： Forty full- term newborns with pulmonary hemorrhage were equally randomized into PS group （mechan- ical ventilation q-PS and instillation of hemo- eoagulase via endotracheal tube,n=20） and con- trol group（mechanical ventilation ＋ hemocoagu- lase instillation via endotracheal tube, n= 20）. The blood was obtained in the two groups via ra- dial artery respectively at 6 , 12 ,24 h after in- tervention for blood gas analysis. Other data were maintained concerning the indexes of re- spiratory mechanics（PIP and Crs）, oxygen ki- netic（PaCO2 ,PaO2 and PaOz/FiO2）, case fatali- ty rate, mean time for stoppage of pulmonary hemorrhage and withdrawal of the breathing ap- paratus. RESULTS. In PS group, 18 cases were cured and 2 cases died, and in the controls, 17cases were cured and death occurred in 3 cases. The case fatality rate was 10% vs 15% for the two groups, there was no statistically significant difference （P〉0.05）. The time for hemorrhage stoppage and withdrawal of the ventilator was significantly reduced in PS group, and the inde- xes of PIP at each time point were lower, where- as the levels of Crs, PaO2 and PaO2/FiO2 were elevated; compared with the controls, there were statistically significant difference （ all P 〈0.05）, while there was no statistically signifi- cant difference about the PaO2 at each point （all P〈 0.05） had no difference. CONCLUSION： The exogenous PS is safe and effective in treat- ment of full-term neonates with pulmonary hem-orrhage.