中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2015年
11期
1707-1711,1712
,共6页
呼吸窘迫综合征%肺表面活性物质%早产儿%剂量效应关系
呼吸窘迫綜閤徵%肺錶麵活性物質%早產兒%劑量效應關繫
호흡군박종합정%폐표면활성물질%조산인%제량효응관계
Respiratory distress syndrome%Pulmonary surfactant%Premature infant%The dose effect relationship
目的:探讨猪肺表面活性物质(进口)与牛肺表面活性物质(国产)分别采用足量和低量早期治疗晚期早产儿呼吸窘迫综合征的临床效果、安全性和成本,为临床选择治疗方案提供参考。方法呼吸窘迫综合征晚期早产儿分为足量 A 组24例,低量 A 组25例,足量 B 组26例,低量 B 组24例。足量 A 组首剂量猪肺表面活性物质为200 mg/kg,低量 A 组首剂量猪肺表面活性物质为100 mg/kg,再次给药剂量均为100 mg/kg;足量 B 组首剂量牛肺表面活性物质为70 mg/kg,低量 B 组首剂量猪肺表面活性物质为50 mg/kg,再次给药剂量均为50 mg/kg。观察各组临床疗效。结果两个低量组治疗后动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、吸氧浓度(FiO2)、氧合指数(OI)与足量 A 组比较差异均有统计学意义,足量 B 组6 h的 PaCO2、FiO2与足量 A 组差异均有统计学意义(q =3.273、3.236,均 P <0.05)。低量 A 组6 h 的 PaO2与足量 B 组差异有统计学意义(q =3.823,P <0.05),12 h 的 PaO2、PaCO2、FiO2、OI 与足量 B 组差异有统计学意义(q =3.293、3.923、3.423、3.434,均 P <0.05),24 h 的 FiO2、OI 明显低于足量 B 组(q =3.234、3.356,均 P <0.05)。低量 B 组6 h、12 h、24 h 的 PaO2明显低于足量 B 组,6 h、12 h 的 PaCO2均明显高于足量 B 组(q =3.892、3.922、3.583,均 P <0.05),12 h、24 h 的 FiO2、OI 均明显高于足量 B 组(1 h 的 q =3.892、3.762,24 h 的q =3.819、3.678,均 P <0.05),24 h 的 OI 明显高于低量 A 组(q =3.784,P <0.05)。X 线胸片评价12 h、24 h各组分级差异有统计学意义(Z =3.982、5.323,P <0.05)。两低量组呼吸机相关性肺炎发生率分别为16.00%、16.67%,均明显高于两足量组(低量 A 组χ2=4.988、5.023,低量 B 组χ2=5.102、5.234,均 P <0.05)。结论猪肺表面活性物质和牛肺表面活性物质足量早期治疗晚期早产儿呼吸窘迫综合征均可明显缓解肺部症状和体征,效果均优于低量,且有较高安全性,低量治疗并不能降低治疗成本,牛肺表面活性物质足量给药治疗成本更低,应根据具体需求选择适合的治疗方案。
目的:探討豬肺錶麵活性物質(進口)與牛肺錶麵活性物質(國產)分彆採用足量和低量早期治療晚期早產兒呼吸窘迫綜閤徵的臨床效果、安全性和成本,為臨床選擇治療方案提供參攷。方法呼吸窘迫綜閤徵晚期早產兒分為足量 A 組24例,低量 A 組25例,足量 B 組26例,低量 B 組24例。足量 A 組首劑量豬肺錶麵活性物質為200 mg/kg,低量 A 組首劑量豬肺錶麵活性物質為100 mg/kg,再次給藥劑量均為100 mg/kg;足量 B 組首劑量牛肺錶麵活性物質為70 mg/kg,低量 B 組首劑量豬肺錶麵活性物質為50 mg/kg,再次給藥劑量均為50 mg/kg。觀察各組臨床療效。結果兩箇低量組治療後動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2)、吸氧濃度(FiO2)、氧閤指數(OI)與足量 A 組比較差異均有統計學意義,足量 B 組6 h的 PaCO2、FiO2與足量 A 組差異均有統計學意義(q =3.273、3.236,均 P <0.05)。低量 A 組6 h 的 PaO2與足量 B 組差異有統計學意義(q =3.823,P <0.05),12 h 的 PaO2、PaCO2、FiO2、OI 與足量 B 組差異有統計學意義(q =3.293、3.923、3.423、3.434,均 P <0.05),24 h 的 FiO2、OI 明顯低于足量 B 組(q =3.234、3.356,均 P <0.05)。低量 B 組6 h、12 h、24 h 的 PaO2明顯低于足量 B 組,6 h、12 h 的 PaCO2均明顯高于足量 B 組(q =3.892、3.922、3.583,均 P <0.05),12 h、24 h 的 FiO2、OI 均明顯高于足量 B 組(1 h 的 q =3.892、3.762,24 h 的q =3.819、3.678,均 P <0.05),24 h 的 OI 明顯高于低量 A 組(q =3.784,P <0.05)。X 線胸片評價12 h、24 h各組分級差異有統計學意義(Z =3.982、5.323,P <0.05)。兩低量組呼吸機相關性肺炎髮生率分彆為16.00%、16.67%,均明顯高于兩足量組(低量 A 組χ2=4.988、5.023,低量 B 組χ2=5.102、5.234,均 P <0.05)。結論豬肺錶麵活性物質和牛肺錶麵活性物質足量早期治療晚期早產兒呼吸窘迫綜閤徵均可明顯緩解肺部癥狀和體徵,效果均優于低量,且有較高安全性,低量治療併不能降低治療成本,牛肺錶麵活性物質足量給藥治療成本更低,應根據具體需求選擇適閤的治療方案。
목적:탐토저폐표면활성물질(진구)여우폐표면활성물질(국산)분별채용족량화저량조기치료만기조산인호흡군박종합정적림상효과、안전성화성본,위림상선택치료방안제공삼고。방법호흡군박종합정만기조산인분위족량 A 조24례,저량 A 조25례,족량 B 조26례,저량 B 조24례。족량 A 조수제량저폐표면활성물질위200 mg/kg,저량 A 조수제량저폐표면활성물질위100 mg/kg,재차급약제량균위100 mg/kg;족량 B 조수제량우폐표면활성물질위70 mg/kg,저량 B 조수제량저폐표면활성물질위50 mg/kg,재차급약제량균위50 mg/kg。관찰각조림상료효。결과량개저량조치료후동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、흡양농도(FiO2)、양합지수(OI)여족량 A 조비교차이균유통계학의의,족량 B 조6 h적 PaCO2、FiO2여족량 A 조차이균유통계학의의(q =3.273、3.236,균 P <0.05)。저량 A 조6 h 적 PaO2여족량 B 조차이유통계학의의(q =3.823,P <0.05),12 h 적 PaO2、PaCO2、FiO2、OI 여족량 B 조차이유통계학의의(q =3.293、3.923、3.423、3.434,균 P <0.05),24 h 적 FiO2、OI 명현저우족량 B 조(q =3.234、3.356,균 P <0.05)。저량 B 조6 h、12 h、24 h 적 PaO2명현저우족량 B 조,6 h、12 h 적 PaCO2균명현고우족량 B 조(q =3.892、3.922、3.583,균 P <0.05),12 h、24 h 적 FiO2、OI 균명현고우족량 B 조(1 h 적 q =3.892、3.762,24 h 적q =3.819、3.678,균 P <0.05),24 h 적 OI 명현고우저량 A 조(q =3.784,P <0.05)。X 선흉편평개12 h、24 h각조분급차이유통계학의의(Z =3.982、5.323,P <0.05)。량저량조호흡궤상관성폐염발생솔분별위16.00%、16.67%,균명현고우량족량조(저량 A 조χ2=4.988、5.023,저량 B 조χ2=5.102、5.234,균 P <0.05)。결론저폐표면활성물질화우폐표면활성물질족량조기치료만기조산인호흡군박종합정균가명현완해폐부증상화체정,효과균우우저량,차유교고안전성,저량치료병불능강저치료성본,우폐표면활성물질족량급약치료성본경저,응근거구체수구선택괄합적치료방안。
Objective To investigate the clinical,safety and cost effect of porcine pulmonary surfactant (import)and bovine pulmonary surfactant(domestic)with full dose and low dosage of early treatment for late preterm children with respiratory distress syndrome,for the clinical selection treatment programs provide a reference.Methods Late preterm children with respiratory distress syndrome were divided into full dose group A of 24 cases,low dose group A of 25 cases,full dose group B of 26 cases,low dose group B of 24 cases.The first dose of full dose group A was 200mg/kg,the first dose of low dosage group A was 100mg/kg,again administered doses was 100mg/kg,the first dose of full dose group B was 70mg/kg,the first dose of low dosage group B was 50mg/kg,again administered dose was 50mg/kg.Results The differences of PaO2 ,PaCO2 ,FiO2 ,OI between two low dosage groups and full dose group A were significantly different.Treated 6h,the differences of PaCO2 ,FiO2 between low dosage group B and full dose group A were significantly different(q =3.273,3.236,all P <0.05).A group of low volume with a sufficient amount PaO2 6 h B group differences were statistically significant(q =3.823,P <0.05),12h of PaO2 ,PaCO2 ,FiO2 ,OI with enough B group difference was statistically significant(q =3.293,3.923,3.423,3.434,all P <0.05),24h of FiO2 , OI group was significantly lower than the full amount of B(q =3.234,3.356,all P <0.05).Low dose group B 6h, 12h,24h of PaO2 was significantly lower than enough group B,6h,12h of PaCO2 were significantly higher than enough group B(q =3.892,3.922,3.583,all P <0.05),12h,24h of FiO2 ,OI group were significantly higher than a suffi cient amount B(12h of q =3.892,3.762,24h of q =3.819,3.678,P <0.05),24h of OI was significantly higher than the low amount of a group(q =3.784,P <0.05).Chest evaluation 12h,24h grade difference between groups was sta-tistically significant(Z =3.982,5.323,all P <0.05).Two low -volume set of ventilator -associated pneumonia rates were 16.00%,16.67%,significantly higher than the amount of the two -legged group(low dose group A χ2 =4.988, 5.023,low dose group B χ2 =5.102,5.234,all P <0.05).Conclusion Porcine pulmonary surfactant(import)and bovine pulmonary surfactant(domestic)full dose early treatment of late preterm children with respiratory distress syn-drome could significantly relieve pulmonary symptoms and signs,effects are better than low dosage,and has high secu-rity,low dosage treatment does not reduce the cost of treatment,bovine pulmonary surfactant therapy administered in an amount sufficient lower cost,select the appropriate treatment plan based on your specific needs.