猪肺表面活性物质联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征的疗效观察

Clinical efficacy of porcine pulmonary surfactant combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome

摘要:

目的 探讨猪肺表面活性物质（PS）联合布地奈德混悬液气管内滴入治疗新生儿胎粪吸入综合征（MAS）的临床效果。方法 采用前瞻性研究法，将70 例MAS新生儿随机分成治疗组与对照组（n=35）。对照组常规给予气管内滴入PS（100 mg/kg）治疗，治疗组在此基础上加用布地奈德（0.25 mg/kg）治疗。结果 治疗组在治疗后12 h需重复使用PS的比例明显低于对照组（P < 0.05）。治疗组在治疗后6 h、12 h、24 h动脉氧分压与吸入氧浓度比值（PaO₂/FiO₂）、经皮血氧饱和度（TcSaO₂）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）的改善情况明显优于对照组（P < 0.05）。治疗后48 h胸片显示治疗组肺部炎症吸收明显优于对照组（P < 0.05）；治疗组并发症的发生率明显低于对照组（P < 0.05），平均住院时间也较对照组明显缩短（P < 0.01）。结论 与单用PS比较，PS联合布地奈德混悬液气管内滴入治疗新生儿MAS能更好改善血气指标和临床症状，缩短住院时间，减少并发症。

Abstract:

Objective To study the clinical efficacy of porcine pulmonary surfactant (PS) combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome (MAS). Methods Seventy neonates with MAS were enrolled for a prospective study. The neonates were randomly assigned to PS alone treatment group and PS+budesonide treatment group (n=35 each). The PS alone treatment group was given PS (100 mg/kg) by intratracheal instillation. The treatment group was given budesonide suspension (0.25 mg/kg) combined with PS (100 mg/kg). Results The rate of repeated use of PS in the PS+ budesonide group was significantly lower than that in the PS alone group 12 hours after treatment (P < 0.05). The improvement of PaO₂/FiO₂, TcSaO₂, PaO₂, and PaCO₂ in the PS+ budesonide group was significantly greater than that in the PS alone group 6, 12, and 24 hours after treatment (P < 0.05). The chest X-ray examination showed that the pulmonary inflammation absorption in the PS+ budesonide group was significantly better than that in the PS alone group 48 hours after treatment (P < 0.05). The incidence of complications in the PS+budesonide group was significantly lower than that in the PS alone group (P < 0.05), and the average hospitalization duration was significantly shorter than that in the PS alone group (P < 0.01). Conclusions PS combined with budesonide suspension intratracheal instillation for the treatment of neonatal MAS is effective and superior to PS alone treatment.