余杨

[摘要] 目的 研究肺表面活性物质（PS）联合鼻塞式持续气道正压通气（n-CPAP）治疗新生儿胎粪吸入综合征的临床意义。 方法 收集我院新生儿科2015年1月～2016年5月收治的79例新生儿胎粪吸入综合征患儿，根据是否使用肺表面活性物质分为观察组（38例）及对照组（41例），对比两组治疗前与治疗后6 h、12 h、24 h PO2/FiO2和a/APO2比值、n-CPAP使用时间、用氧时间、平均住院天数、改为有创呼吸支持例数等临床指标。 结果 观察组治疗后6 h、12 h、24 h PO2/FiO2、a/APO2比值较对照组明显改善，差异有统计学意义（P<0.05）；n-CPAP使用时间、用氧时间、平均住院天数较对照组缩短，差异有统计学意义（P<0.05）；观察组改为有创呼吸支持例数较对照组少，差异有统计学意义（P<0.05）。 结论 PS联合n-CPAP治疗新生儿胎粪吸入综合征疗效确切，操作简便，适宜临床推广应用。

[关键词] 肺表面活性物质；鼻塞式持续气道正压通气；新生儿；胎粪吸入综合征

[中图分类号] R722.1 [文献标识码] B [文章编号] 1673-9701（2016）25-0048-03

Clinical significance of pulmonary surfactant combined with nasal continuous positive airway pressure in the treatment of neonatal aspiration of meconium

YU Yang

Department of Neonatology， Anshun Women and Childrens Hospital in Guizhou Province， Anshun 561000， China

[Abstract] Objective To study the clinical significance of pulmonary surfactant combined with nasal continuous positive airway pressure（n-CPAP） in the treatment of neonatal aspiration of meconium. Methods 79 children patients with neonatal aspiration of meconium who were admitted to the Department of Neonatology in our hospital from January 2015 to May 2016 were selected. According to whether pulmonary surfactant was used or not， the patients were assigned to the observation group （38 patients） and the control group （41 patients）. Clinical indicators of PO2/FiO2 and a/APO2 ratios， n-CPAP application time， oxygen time， average length of stay， number of cases of changing to invasive respiratory support before the treatment， 6 hours， 12 hours， and 24 hours after the treatment were compared between the two groups. Results PO2/FiO2 and a/APO2 ratios 6 hours， 12 hours， and 24 hours after the treatment were significantly improved compared with those in the control group， and the differences were statistically significant （P<0.05）； n-CPAP application time， oxygen time and average length of stay were shorter than those in the control group， and the differences were statistically significant（P<0.05）； number of cases of changing to invasive respiratory support in the observation group was less than that in the control group， and the difference between groups was statistically significant（P<0.05）. Conclusion PS combined with n-CPAP in the treatment of neonatal aspiration of meconium has exact curative effects and convenient operating procedures， which is suitable for clinical promotion and application.

[Key words] Pulmonary surfactant； Nasal continuous positive airway pressure（n-CPAP）； Newborns； Aspiration of meconium

新生儿胎粪吸入综合征（meconiurn aspiration syndrome，MAS）或称为胎粪吸入性肺炎是产前或产时发生的最常见的吸入性肺炎，多见于足月儿或过期产儿，严重MAS易并发急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）、新生儿持续肺动脉高压（persistent pulmonary hypertension，PPHN）、呼吸衰竭，增加患儿死亡风险。在基层医院，该病发生率和死亡率仍高[1]，选取安全、有效、操作简便的措施降低MAS的发生率、死亡率具有重要意义，本文着重探讨MAS的治疗措施。我院新生儿科予肺表面活性物质（pulmonary surfactant，PS）联合鼻塞式持续气道正压通气（nasal continuous positive airway pressure ventilation，n-CPAP）治疗MAS，取得较好的临床疗效，现报道如下。

1 资料与方法

1.1一般资料

选取本院新生儿科2015年1月～2016年5月收治的79例新生儿胎粪吸入综合征患儿，根据家属自愿原则决定是否使用PS，按是否使用PS进行分组，使用PS为观察组，未用PS为对照组。观察组38例，对照组41例。观察组男22例，女16例，平均胎龄（39.84±1.52）周，平均出生体重（3355±327）g，入院平均时龄（4.31±1.38）h。……