CAJ | 학술논문

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的临床疗效。方法将本科2010年1月至2013年6月收治的足月儿重症 MAS 136例，按 Apgar 评分0~3、4~7、≥8分进行分层，然后随机分为 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），各68例。灌洗组采用稀释后的 PS 3~5 ml/次（浓度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小时的血气分析、氧合指数（OI）值、吸入氧浓度比（P/ F）比值的动态变化，比较两组患儿的上机时间、并发症、治愈率。结果灌洗组在 PS 使用前和使用后2小时的 PaO2、PaCO2、OI 值、P/F 比值与注入组相比差异均无显著性（P ＞0.05），但在 PS 使用后的12、24、48小时上述指标灌洗组均要优于注入组（P＜0.01）。灌洗组的上机时间（65.2±11.8）小时，注入组为（78.6±13.5）小时（t=6.12，P＜0.01）；灌洗组治愈66/68（97.1%），注入组治愈60/68（88.2%）（χ2=3.89，P ＜0.05）；灌洗组并发症2/68（2.9%）；注入组并发症9/68（13.2%）（χ2=4.85，P ＜0.05）。结论 PS 稀释后进行气管内灌洗在改善通气和提高氧合效率方面优于 PS 气管内注入，并可减少上机时间，减少并发症，提高治愈率，且安全有效，值得临床上推广应用。
목적：연구저폐표면활성물질（PS）기관내관세치료중증신생인태분흡입종합정적림상료효。방법장본과2010년1월지2013년6월수치적족월인중증 MAS 136례，안 Apgar 평분0~3、4~7、≥8분진행분층，연후수궤분위 PS 기관내관세치료조（관세조）화 PS 기관내주입치료조（주입조），각68례。관세조채용희석후적 PS 3~5 ml/차（농도12 mg/ml）기관내관세；주입조채용 PS원액200 mg/kg（수제）기관내주입。비교량조환인치료전급치료후2、12、24、48소시적혈기분석、양합지수（OI）치、흡입양농도비（P/ F）비치적동태변화，비교량조환인적상궤시간、병발증、치유솔。결과관세조재 PS 사용전화사용후2소시적 PaO2、PaCO2、OI 치、P/F 비치여주입조상비차이균무현저성（P ＞0.05），단재 PS 사용후적12、24、48소시상술지표관세조균요우우주입조（P＜0.01）。관세조적상궤시간（65.2±11.8）소시，주입조위（78.6±13.5）소시（t=6.12，P＜0.01）；관세조치유66/68（97.1%），주입조치유60/68（88.2%）（χ2=3.89，P ＜0.05）；관세조병발증2/68（2.9%）；주입조병발증9/68（13.2%）（χ2=4.85，P ＜0.05）。결론 PS 희석후진행기관내관세재개선통기화제고양합효솔방면우우 PS 기관내주입，병가감소상궤시간，감소병발증，제고치유솔，차안전유효，치득림상상추엄응용。
Objective To explore the clinical effect of endotracheal lavage with porcine pulmonary surfactant(PS) among newborns with severe meconium aspiration syndrome. Method 136 term infants with severe meconium aspiration syndrome from January, 2010 to June, 2013 were enrolled at our department. All the cases were stratified into 3 groups based on Apgar score of 0-3,4-7,and≥8,And then, all the 136 cases were randomly divided into two groups:PS endotracheal lavage group(lavage group ,68 cases) and PS intratracheal injection group(injection group ,68 cases).Lavage group was treated with 3-5 ml PS attenuant every time(concentration:12 mg/ml), while injection group with 200 mg/kg PS original fluid (first dose).The data about Blood gas analysis,oxygen index(OI) and PaO2/ FiO2 (P/F)were collected and compared before treatment and 2h,12h,24h, and 48 h after treatment. The data about the duration of mechanical ventilation,the complication rate and the cure rate were also compared. Result There was no significant difference on PaO2,PaCO2,OI, P/F before treatment and 2 hours after treatment between the two groups (P>0.05).Compared the data of 12h,24h,and 48h after treatment,the lavage group was better than injection group(P<0.01).The duration of mechanical ventilation in lavage group(65.2±11.8)h was less than that in injection group(78.6±13.5)h(t=6.12, P<0.01).The cure rate of lavage group 66/68 cases (97.1%) was higher than that in injection group 60/68 cases (88.2%)(χ2=3.89,P<0.05).The complication rate of lavage group 2/68 cases (2.9%) was lower than that in injection group 9/68 cases (13.2%) (χ2=4.85, P<0.05). Conclusion The clinical effect of endotracheal lavage with PS attenuant is better than intratracheal injection with PS original fluid on improving ventilation and oxygenation efficiency, and also can decrease the duration of mechanical ventilation and the complication rate,while increase the cure rate. The method of endotracheal lavage with PS attenuant is safe, effective and worth widely using in clinical treatment.