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目的探讨肺表面活性物质治疗早产儿肺透明膜病在地市级医院的应用。方法选择2002年2月至2010年10月本院新生儿重症监护病房收治的早产儿肺透明膜病(HMD)患儿,使用肺表面活性物质(PS)治疗者为观察组,未使用者为对照组,比较两组呼吸机参数、血气分析、胸部X线变化,以及使用呼吸机时间、住院时间及转归情况。结果观察组128例,对照组78例,两组胎龄、体重、HMD分级等差异均无统计学意义(P>0.05)。(1)观察组用药后氧浓度、吸气峰压和平均气道压均较用药前逐渐降低(P<0.05);(2)观察组治疗后PaO2和pH值较对照组升高、PaCO2较对照组降低(P均<0.05);(3)观察组应用PS后12 h,胸部X线肺充气情况好转,24 h肺透亮度明显增加,肺膨胀良好,72 h后117例完全恢复正常,其余11例亦明显改善;对照组于治疗后72 h复查胸部X线仅45例完全恢复正常;(4)观察组应用呼吸机时间、住院天数、病死率均低于对照组(P均<0.05)。结论应用PS治疗可提高地市级医院早产儿HMD的救治水平。
Objective To investigate the application of pulmonary surfactant in the treatment of preterm neonates with hyaline membrane disease in municipal hospitals. Methods From February 2002 to October 2010 in our hospital neonatal intensive care unit admitted to premature children with hyaline membrane disease (HMD) in children, the use of pulmonary surfactant (PS) treatment for the observation group, unused In the control group, ventilator parameters, blood gas analysis, chest X-ray changes, ventilator time, hospital stay and outcome were compared between the two groups. Results There were 128 cases in the observation group and 78 cases in the control group. There was no significant difference in gestational age, weight, HMD grade between the two groups (P> 0.05). (1) The oxygen concentration, peak inspiratory pressure and mean airway pressure in the observation group were lower than those before treatment (P <0.05); (2) PaO2 was higher in the observation group than in the control group (P <0.05). (3) In the observation group, the chest X-ray lung condition was improved 12 h after PS administration, lung permeability increased significantly at 24 h, lung expansion was good, and 117 cases recovered completely after 72 h, While the other 11 cases also improved obviously. In the control group, only 45 cases of chest X-ray were completely recovered at 72 hours after treatment. (4) The use of respirator, hospital stay and mortality in the observation group were lower than those in the control group (all P <0.05 ). Conclusion The application of PS therapy can improve the level of treatment of HMD in preterm infants in municipal hospitals.