目的 研究猪肺表面活性物质（PS）气管内灌洗治疗重症新生儿胎粪吸入综合征（MAS）的临床疗效。方法 2010 年1 月至 2013 年6 月收治的重症MAS 足月儿136 例, 随机分为PS 气管内灌洗治疗组（灌洗组）和PS 气管内注入治疗组（注入组），每组68 例。灌洗组采用稀释后的PS 3~5 mL/次（12 mg/mL）气管内灌洗；注入组采用PS 原液200 mg/kg（首剂）气管内注入。比较两组患儿治疗前及治疗后2、12、24、48 h的血气分析、OI 值、P/F 值的动态变化，以及两组患儿的上机时间、并发症、治愈率。结果 灌洗组在PS 使用后的12 h、24 h、48 h PaO2、PaCO2、OI、P/F 值均优于注入组（P<0.01）。灌洗组的上机时间短于注入组（P<0.01），平均应用PS 数量少于注入组（P<0.01）；灌洗组治愈率（97%）高于注入组（88%）（P<0.05），并发症发生率低于注入组（P<0.05）。结论 PS 稀释后进行气管内灌洗在改善通气和氧合方面优于PS 气管内注入，并可减少上机时间，减少并发症，提高治愈率。
Abstract
Objective To evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant (PS) in term neonates with severe meconium aspiration syndrome (MAS). Methods A total of 136 full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January 2010 and June 2013 were randomly and equally divided into PS lavage and PS injection groups. In the PS lavage group, patients were treated with endotracheal lavage using 3-5 mL of diluted PS (12 mg/mL) each time, and the PS injection group was given PS by intratracheal injection at the first dose of 200 mg/kg. Blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) of the two groups were evaluated before and 2, 12, 24, and 48 hours after the treatment, and the duration of mechanical ventilation, complication rate, and cure rate were compared between the two groups. Results Compared with the PS injection group, the PS lavage group had significantly higher PaO2 and P/F ration and significantly lower PaCO2 and OI at 12, 24, and 48 hours post-treatment (P<0.01), a significantly shorter duration of mechanical ventilation (P<0.01), a significantly smaller amount of PS (P<0.01), a significantly lower complication rate (P<0.05), and a significantly higher cure rate (97% vs 88%; P<0.05). Conclusions Compared with the intratracheal injection of PS, endotracheal lavage with diluted PS in term neonates with severe MAS can increase ventilation and oxygenation efficiency, shorten the duration of mechanical ventilation, reduce the complication rate, and increase the cure rate, indicating that this method is a safe and effective therapeutic strategy.
关键词
胎粪吸入综合征 /
肺表面活性物质 /
高频振荡通气 /
新生儿
Key words
Meconium aspiration syndrome /
Pulmonary surfactant /
High-frequency oscillatory ventilation /
Neonate
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