CAJ | 학술논문

目的：探讨高频振荡通气（HFOV）联合肺表面活性物质（PS）治疗新生儿肺出血（NPH）的临床疗效。方法将2010年1月至2014年6月确诊为NPH的122例患儿，按胎龄分层后，随机分为HFOV+PS治疗组（简称试验组）和单纯HFOV治疗组（简称对照组），每组61例。两组患儿均在发生NPH后行HFOV，试验组在行HFOV后2~4 h给予气管内注入PS，然后继续HFOV。观察两组患儿上机时及上机后6、12、24 h的血气分析、OI值、PaO2/FiO2（P/F）值的动态变化，比较两组患儿的肺出血时间、上机时间、并发症和治愈率。结果试验组在上机后6、12、24 h的PaO2、PaCO2、OI值、PaO2/FiO2（P/F）值均要优于对照组（P<0.05）；试验组的肺出血停止时间及上机时间均短于对照组（P<0.01），且并发症发生率低于对照组（P<0.05）；试验组治愈率（87%）与对照组（82%）相比差异无统计学意义（P>0.05）。结论 HFOV联合PS治疗NPH可以改善氧合，缩短NPH时间及上机时间，减少并发症的发生，但与单纯HFOV相比并不能降低病死率。
목적：탐토고빈진탕통기（HFOV）연합폐표면활성물질（PS）치료신생인폐출혈（NPH）적림상료효。방법장2010년1월지2014년6월학진위NPH적122례환인，안태령분층후，수궤분위HFOV+PS치료조（간칭시험조）화단순HFOV치료조（간칭대조조），매조61례。량조환인균재발생NPH후행HFOV，시험조재행HFOV후2~4 h급여기관내주입PS，연후계속HFOV。관찰량조환인상궤시급상궤후6、12、24 h적혈기분석、OI치、PaO2/FiO2（P/F）치적동태변화，비교량조환인적폐출혈시간、상궤시간、병발증화치유솔。결과시험조재상궤후6、12、24 h적PaO2、PaCO2、OI치、PaO2/FiO2（P/F）치균요우우대조조（P<0.05）；시험조적폐출혈정지시간급상궤시간균단우대조조（P<0.01），차병발증발생솔저우대조조（P<0.05）；시험조치유솔（87%）여대조조（82%）상비차이무통계학의의（P>0.05）。결론 HFOV연합PS치료NPH가이개선양합，축단NPH시간급상궤시간，감소병발증적발생，단여단순HFOV상비병불능강저병사솔。
ObjectiveTo explore the clinical efifcacy of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal pulmonary hemorrhage (NPH).MethodsA total of 122 neonates diagnosed with NPH between January 2010 and June 2014 were enrolled. After being stratiifed by gestational age, the neonates were randomly divided into treatment (HFOV+PS) and control (HFOV alone) groups (n=61 each). Both groups were treated with HFOV after the onset of NPH. After 2-4 hours of HFOV treatment, the treatment group received PS via intratracheal injections, followed by continuous use of HFOV. Dynamic changes in the blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) values of the neonates were determined before HFOV treatment and after 6, 12, and 24 hours of HFOV treatment. The time to hemostasis, duration of ventilation, incidence of complications, and cure rate were compared between groups.ResultsAfter 6, 12, and 24 hours of HFOV treatment, the treatment group had significantly improved PaO2, PaCO2, O/I, and P/F values compared with the control group (P<0.05). The time to hemostasis and the duration of ventilation were signiifcantly shorter in the treatment group than in the control group (P<0.01), and the incidence of complications was lower in the former than in the latter (P<0.05). There was no signiifcant difference in the cure rate between the treatment (87%) and control (82%) groups (P>0.05).Conclusions HFOV combined with PS is an effective treatment to improve oxygenation, shorten the time to hemostasis and the duration of ventilation, and reduce the incidence of complications in neonates with NPH. However, the dual therapy is unable to reduce the mortality of neonates compared with HFOV monotherapy.