本文選題：晚期早產兒 + 急性呼吸衰竭　； 參考：《青島大學》2012年碩士論文

【摘要】：目的：探討外源性肺表面活性物質(pulmonary surfactant, PS)替代治療技術在晚期早產兒急性呼吸衰竭(Acute Respiratory Failure, ARF)中的應用及療效。 方法：采用前瞻性隊列研究方法,收集2010年1月-2011年6月青島市婦女兒童醫(yī)院新生兒科重癥監(jiān)護室(Neonatal Intensive Care Unit, NICU)收治的共60例發(fā)生ARF的晚期早產兒作為研究對象,按家長是否同意應用PS分為治療組和對照組,治療組經家長同意后盡早予以牛肺灌洗液提取物珂立蘇,對照組未應用PS。兩組患兒均需應用呼吸機輔助通氣治療。記錄各組患兒在治療后1h、6h、24h的臨床癥狀、呼吸窘迫評分、血氣分析結果、呼吸機參數、持續(xù)上機時間、EL ISA法檢測炎性因子(IL-6、IL-8. TNF-α)的變化、住院天數、住院費用、并發(fā)癥和合并癥的產生及預后。 結果： 1、治療組患兒應用PS后1小時發(fā)紺改善20例,經皮測氧飽和度(SP02)上升至90%以上者18例,三凹征明顯減輕或消失者17例。對照組患兒應用PS后1小時發(fā)紺改善23例,經皮測氧飽和度(SPO2)上升至90%以上者25例,三凹征明顯減輕或消失者21例。兩組患兒在應用PS前及用藥后1h、6h分別重復新生兒呼吸窘迫評分,差異有統(tǒng)計學意義。 2、在血氣分析中,應用PS替代治療的晚期早產兒用藥后1小時的PC02、用藥后24小時的TCO：較未應用PS治療的對照組顯著下降,用藥后1小時、6小時及24小時的PO2較對照組明顯升高,差異顯著(P0.05)。 3、在呼吸機參數調節(jié)中,應用PS替代治療的晚期早產兒在用藥后1小時、6小時及24小時,FiO2、PEEP/PIP均較對照組明顯下降,OI值升高,參數下調順利,上機總持續(xù)時間縮短,呼吸機撤機順利,重復上機者較少,差別有統(tǒng)計學意義(P0.05)。 4、應用PS替代治療的晚期早產兒因機械通氣產生的并發(fā)癥與并發(fā)癥較對照組少,治療組22例患兒中有6例出現了并發(fā)癥及合并癥(27.27%),其中動脈導管未閉2例(PDA,9.10%),其余肺部感染性疾病4例(18.18%)；對照組38例中有13例出現了并發(fā)癥及合并癥(34.21%),其中動脈導管未閉3例(7.89%)、肺部感染性疾病7例(10.53%)、氣胸2例(13.16%)、肺動脈高壓1例(2.63%)。 5、收集血清樣本共28例,其中治療組9例,對照組19例。兩組患兒急性期血清IL-6、IL-8和TNF-α水平均顯著高于恢復期；治療組IL-8水平在恢復期下降的差值較對照組明顯,有統(tǒng)計學意義；急性期和恢復期血清TNF-α水平與IL-6、IL-8水平均呈正相關。 6、治療組治愈20例,死亡及放棄治療者2例；對照組治愈35例,死亡及放棄治療者3例。治療組NICU住院天數(13.55+4.43)天、住院花費(8352.82±4767.89)元,對照組NICU住院天數(18.05+7.72)天、住院花費(13128.62±4544.12)元。治療組的住院天數及住院的花費均較對照組明顯減少,差別有統(tǒng)計學意義(P0.05)。 結論：PS在晚期早產兒急性呼吸衰竭的搶救中療效顯著。
[Abstract]:Objective: to investigate the application and efficacy of exogenous pulmonary surfactant (pulmonary surfactant, PS) replacement therapy in advanced premature acute respiratory failure (ARF). Methods: a prospective cohort study was used to study 60 advanced premature infants with ARF in Neonatal intensive Care Unit (NICU) of Qingdao Women and Children's Hospital from January 2010 to June 2011. According to parents' consent, PS was divided into treatment group and control group. The treatment group was treated with bovine lung lavage fluid extract Cosmosu as soon as possible after parents' consent, while the control group was not treated with PSs. Children in both groups were treated with ventilator-assisted ventilation. The clinical symptoms, respiratory distress score, blood gas analysis results, ventilator parameters, and continuous time of operation were recorded to detect the inflammatory factors (IL-6 and IL-8) in each group at 1h and 6h after treatment. Changes in TNF- 偽, length of stay, costs, complications and complications, and prognosis. Results: 1. In the treatment group, cyanosis was improved in 20 cases at 1 hour after PS, transcutaneous oxygen saturation (SP02) increased to more than 90% in 18 cases, and tri-concave sign was alleviated or disappeared in 17 cases. In the control group, cyanosis was improved 1 hour after PS in 23 cases, percutaneous oxygen saturation (SPO _ 2) increased to more than 90% in 25 cases, and triple concave sign was alleviated or disappeared in 21 cases. The scores of neonatal respiratory distress were repeated before PS and 1 h and 6 h after administration of PS, and the difference was statistically significant. 2. In blood gas analysis, there was no significant difference between the two groups. PC02 of late premature infants treated with PS replacement therapy was significantly lower than that of control group at 24 hours after treatment, and PO2 at 1 hour, 6 hours and 24 hours after treatment was significantly higher than that in control group. The difference was significant (P0.05). 3. In the adjustment of ventilator parameters, the PIP of late premature infants treated with PS replacement therapy decreased significantly compared with the control group at 1 hour, 6 hours and 24 hours after treatment, and the parameters decreased smoothly, and the total duration was shortened. Compared with the control group, there were less complications and complications caused by mechanical ventilation in the late premature infants treated with PS replacement therapy, and the difference was statistically significant (P0.05), and there were fewer complications caused by mechanical ventilation in the late premature infants treated with PS replacement therapy than in the control group. In the treatment group, 6 cases (27.27%) had complications and complications, including 2 cases of patent ductus arteriosus (PDA9.10%) and 4 cases of other pulmonary infectious diseases (18.18%). In the control group, 13 cases (34.21%) had complications and complications (34.21%), including 3 cases of patent ductus arteriosus (7.89%), 7 cases of pulmonary infectious diseases (10.53%), 2 cases of pneumothorax (13.16%), 1 case of pulmonary hypertension (2.63%). There were 19 cases in the control group. The serum levels of IL-6, IL-8 and TNF- 偽 in the acute phase of the two groups were significantly higher than those in the convalescent stage, and the difference of IL-8 level in the treatment group was significantly higher than that in the control group. The levels of TNF- 偽 in serum were positively correlated with IL-6 and IL-8 levels in both acute and convalescent stages. 6. In the treatment group, 20 cases were cured, 2 cases died and 2 cases gave up treatment, while 35 cases were cured in the control group and 3 cases died and abandoned the treatment. The days of hospitalization were (13.55 4.43) days in the treatment group and (8352.82 鹵4767.89) yuan in the control group, and (18.05 7.72) days in the control group, and (13128.62 鹵4544.12) yuan in the control group. The days of hospitalization and the cost of hospitalization in the treatment group were significantly lower than those in the control group (P0.05). Conclusion: PS is effective in the treatment of acute respiratory failure of late premature infants.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R722.1

【參考文獻】

相關期刊論文 前10條

1 李珊,陳晶,劉恒,盛紅;沐舒坦在預防早產兒呼吸窘迫綜合征中的療效觀察[J];中國當代兒科雜志;2004年05期

2 胡琴;連金媚;李儉慶;;沐舒坦不同給藥方式預防早產兒呼吸窘迫綜合征療效觀察[J];中國當代兒科雜志;2006年04期

3 鄧琳,方鳳,方超萍,毋永正;氨溴索對哮喘豚鼠肺表面活性物質系統(tǒng)超微結構的影響[J];第二軍醫(yī)大學學報;2000年02期

4 單若冰,王曉亮,譚麗群,仇麗華;新生兒疾病危重度評分預測死亡風險比較[J];中華急診醫(yī)學雜志;2005年04期

5 段慧娟;654-2治療新生兒呼吸衰竭60例療效分析[J];吉林醫(yī)學;2004年08期

6 周曉光;;新生兒急性肺損傷的診斷與治療策略[J];臨床兒科雜志;2008年03期

7 閆亞敏;王志紅;盧健;;肺表面活性蛋白B(SP-B)在肺損傷中的研究進展[J];臨床肺科雜志;2010年06期

8 顧興;金發(fā)光;傅恩清;李學英;劉靜莉;孫亞妮;;細胞因子在ARDS發(fā)病機制中的作用[J];現代生物醫(yī)學進展;2007年09期

9 常立文;李文斌;;新生兒急性肺損傷/急性呼吸窘迫綜合征[J];實用兒科臨床雜志;2007年02期

10 楊曉光;葉貞志;李步云;蘇國云;;肺表面活性物質治療新生兒急性呼吸窘迫綜合征的療效[J];實用兒科臨床雜志;2009年14期

，

本文編號：2115980