外源性肺表面活性物质替代治疗技术在晚期早产儿急性呼吸衰竭中的应用

发布时间：2018-07-11 17:07

本文选题：晚期早产儿 + 急性呼吸衰竭　；参考：《青岛大学》2012年硕士论文

【摘要】：目的：探讨外源性肺表面活性物质(pulmonary surfactant, PS)替代治疗技术在晚期早产儿急性呼吸衰竭(Acute Respiratory Failure, ARF)中的应用及疗效。方法：采用前瞻性队列研究方法,收集2010年1月-2011年6月青岛市妇女儿童医院新生儿科重症监护室(Neonatal Intensive Care Unit, NICU)收治的共60例发生ARF的晚期早产儿作为研究对象,按家长是否同意应用PS分为治疗组和对照组,治疗组经家长同意后尽早予以牛肺灌洗液提取物珂立苏,对照组未应用PS。两组患儿均需应用呼吸机辅助通气治疗。记录各组患儿在治疗后1h、6h、24h的临床症状、呼吸窘迫评分、血气分析结果、呼吸机参数、持续上机时间、EL ISA法检测炎性因子(IL-6、IL-8. TNF-α)的变化、住院天数、住院费用、并发症和合并症的产生及预后。结果： 1、治疗组患儿应用PS后1小时发绀改善20例,经皮测氧饱和度(SP02)上升至90%以上者18例,三凹征明显减轻或消失者17例。对照组患儿应用PS后1小时发绀改善23例,经皮测氧饱和度(SPO2)上升至90%以上者25例,三凹征明显减轻或消失者21例。两组患儿在应用PS前及用药后1h、6h分别重复新生儿呼吸窘迫评分,差异有统计学意义。 2、在血气分析中,应用PS替代治疗的晚期早产儿用药后1小时的PC02、用药后24小时的TCO：较未应用PS治疗的对照组显著下降,用药后1小时、6小时及24小时的PO2较对照组明显升高,差异显著(P0.05)。 3、在呼吸机参数调节中,应用PS替代治疗的晚期早产儿在用药后1小时、6小时及24小时,FiO2、PEEP/PIP均较对照组明显下降,OI值升高,参数下调顺利,上机总持续时间缩短,呼吸机撤机顺利,重复上机者较少,差别有统计学意义(P0.05)。 4、应用PS替代治疗的晚期早产儿因机械通气产生的并发症与并发症较对照组少,治疗组22例患儿中有6例出现了并发症及合并症(27.27%),其中动脉导管未闭2例(PDA,9.10%),其余肺部感染性疾病4例(18.18%)；对照组38例中有13例出现了并发症及合并症(34.21%),其中动脉导管未闭3例(7.89%)、肺部感染性疾病7例(10.53%)、气胸2例(13.16%)、肺动脉高压1例(2.63%)。 5、收集血清样本共28例,其中治疗组9例,对照组19例。两组患儿急性期血清IL-6、IL-8和TNF-α水平均显著高于恢复期；治疗组IL-8水平在恢复期下降的差值较对照组明显,有统计学意义；急性期和恢复期血清TNF-α水平与IL-6、IL-8水平均呈正相关。 6、治疗组治愈20例,死亡及放弃治疗者2例；对照组治愈35例,死亡及放弃治疗者3例。治疗组NICU住院天数(13.55+4.43)天、住院花费(8352.82±4767.89)元,对照组NICU住院天数(18.05+7.72)天、住院花费(13128.62±4544.12)元。治疗组的住院天数及住院的花费均较对照组明显减少,差别有统计学意义(P0.05)。结论：PS在晚期早产儿急性呼吸衰竭的抢救中疗效显著。
[Abstract]:Objective: to investigate the application and efficacy of exogenous pulmonary surfactant (pulmonary surfactant, PS) replacement therapy in advanced premature acute respiratory failure (ARF). Methods: a prospective cohort study was used to study 60 advanced premature infants with ARF in Neonatal intensive Care Unit (NICU) of Qingdao Women and Children's Hospital from January 2010 to June 2011. According to parents' consent, PS was divided into treatment group and control group. The treatment group was treated with bovine lung lavage fluid extract Cosmosu as soon as possible after parents' consent, while the control group was not treated with PSs. Children in both groups were treated with ventilator-assisted ventilation. The clinical symptoms, respiratory distress score, blood gas analysis results, ventilator parameters, and continuous time of operation were recorded to detect the inflammatory factors (IL-6 and IL-8) in each group at 1h and 6h after treatment. Changes in TNF- 伪, length of stay, costs, complications and complications, and prognosis. Results: 1. In the treatment group, cyanosis was improved in 20 cases at 1 hour after PS, transcutaneous oxygen saturation (SP02) increased to more than 90% in 18 cases, and tri-concave sign was alleviated or disappeared in 17 cases. In the control group, cyanosis was improved 1 hour after PS in 23 cases, percutaneous oxygen saturation (SPO _ 2) increased to more than 90% in 25 cases, and triple concave sign was alleviated or disappeared in 21 cases. The scores of neonatal respiratory distress were repeated before PS and 1 h and 6 h after administration of PS, and the difference was statistically significant. 2. In blood gas analysis, there was no significant difference between the two groups. PC02 of late premature infants treated with PS replacement therapy was significantly lower than that of control group at 24 hours after treatment, and PO2 at 1 hour, 6 hours and 24 hours after treatment was significantly higher than that in control group. The difference was significant (P0.05). 3. In the adjustment of ventilator parameters, the PIP of late premature infants treated with PS replacement therapy decreased significantly compared with the control group at 1 hour, 6 hours and 24 hours after treatment, and the parameters decreased smoothly, and the total duration was shortened. Compared with the control group, there were less complications and complications caused by mechanical ventilation in the late premature infants treated with PS replacement therapy, and the difference was statistically significant (P0.05), and there were fewer complications caused by mechanical ventilation in the late premature infants treated with PS replacement therapy than in the control group. In the treatment group, 6 cases (27.27%) had complications and complications, including 2 cases of patent ductus arteriosus (PDA9.10%) and 4 cases of other pulmonary infectious diseases (18.18%). In the control group, 13 cases (34.21%) had complications and complications (34.21%), including 3 cases of patent ductus arteriosus (7.89%), 7 cases of pulmonary infectious diseases (10.53%), 2 cases of pneumothorax (13.16%), 1 case of pulmonary hypertension (2.63%). There were 19 cases in the control group. The serum levels of IL-6, IL-8 and TNF- 伪 in the acute phase of the two groups were significantly higher than those in the convalescent stage, and the difference of IL-8 level in the treatment group was significantly higher than that in the control group. The levels of TNF- 伪 in serum were positively correlated with IL-6 and IL-8 levels in both acute and convalescent stages. 6. In the treatment group, 20 cases were cured, 2 cases died and 2 cases gave up treatment, while 35 cases were cured in the control group and 3 cases died and abandoned the treatment. The days of hospitalization were (13.55 4.43) days in the treatment group and (8352.82 卤4767.89) yuan in the control group, and (18.05 7.72) days in the control group, and (13128.62 卤4544.12) yuan in the control group. The days of hospitalization and the cost of hospitalization in the treatment group were significantly lower than those in the control group (P0.05). Conclusion: PS is effective in the treatment of acute respiratory failure of late premature infants.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1

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