肺表面活性物质治疗新生儿肺内/肺外源性急性肺损伤研究

目的 探讨肺表面活性物质（PS）治疗肺内源性与肺外源性新生儿急性肺损伤（ALI）的治疗效果.方法 选择2010年6月至2012年9月本院新生儿科收治的ALI患儿,按病因分为肺源性组与肺外源性组,均予以肺保护性通气策略机械通气以及PS气管插管内注入,在PS治疗前后监测肺顺应性以及氧合指数（OI）,分析两组患儿的治疗及预后.结果 使用PS前,肺源性组（21例）肺顺应性低于肺外源性组（31例）[（0.23＆#177;0.09）比（0.34＆#177;0.12）,P＜0.05];使用PS后,两组肺顺应性改善明显,均先增高,后逐步回落;使用PS后2、24、48 h肺外源性组肺顺应性均高于肺源性组[2 h：（0.60＆#177;0.21）比（0.35＆#177;0.16）,24 h：（0.54 ＆#177;0.18）比（0.28 ＆#177;0.13）,48 h：（0.55＆#177;0.12）比（0.29＆#177;0.17）,P＜0.05];两组患儿OI在使用PS后均明显改善,使用后2、24、48 h肺外源性组明显低于肺源性组[2 h：（15.1＆#177;2.8）比（20.3＆#177;3.9）,24 h：（18.4＆#177;4.2）比（25.2＆#177;5.3）,48 h：（10.4＆#177;5.6）比（16.4＆#177;4.4）,P＜0.05].肺源性组机械通气时间、住院时间均长于肺外源性组,病死率高于肺外源性组（P＜0.05）.结论 新生儿肺源性与肺外源性ALI存在肺顺应性的差异;肺外源性ALI对PS治疗的反应优于肺源性ALI.

Effects of exogenous pulmonary surfactant in the treatment of pulmonary and extrapulmonary acute lung injury in neonates

Objective To determine the therapeutic effect of exogenous pulmonary surfactant （PS） on pulmonary and extrapulmonary acute lung injure （ALI） in neonates. Methods A prospective study was conducted in the Neonatal Intensive Care Unit （NICU） between June. 2010 and September. 2012. Neonates with ALI were grouped into pulmonary and extrapulmonary groups according to different pathogeneses, 21 neonates in pulmonary group, and 31 in extrapulmonary group. All patients received protective ventilation and intratracheally given exogenous PS. Lung compliance and oxygenation index（OI） were recorded at different time point before and after PS treatment. Results Before PS was given, lung compliance in pulmonary group was lower than that of the extrapulmonary group （ P 〈 0. 05 ） , which improved significantly after PS in both groups. But at specific time point （ at 2, 24, 48 h） the lung compliance in extrapulmonary group was higher comparing with the pulmonary group [ 2 h ： （0. 60 -± 0. 21 ） vs. （0. 35 ±0. 16） ,24 h： （0. 54 ± 0. 18） vs. （0. 28 ±0. 13） ,48 h： （0.55 ±0. 12） vs. （0. 29 ±0. 17）,P 〈 0. 05 ]. OI improved after PS in both groups, but OI in extrapulmonary group was lower comparing with the pulmonary group[2 h：（15.1 ±2. 8）vs. （20.3 ±3.9） ,24 h：（18.4 ±4.2）vs. （25.2 ±5.3）, 48 h： （ 10.4 ± 5.6 ） vs. （ 16.4 ± 4.4 ）, P 〈 0. 05 ]. The duration of ventilation and hospital stay in pulmonary group were longer than that of the extrapulmonary group （P 〈 0.05 ）;the mortality in pulmonary group was higher than the extrapulmonary group. Conclusions Lung compliance is between pulmonary ALl and extrapulmonary ALI in neonates; the response of PS supplementation for extrapulmonary ALI was better than pulmonary ALI in neonates.