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目的:研究应用机械通气联合肺表面活性物质治疗新生儿重症肺炎合并呼吸衰竭的临床疗效。方法:回顾性分析2012年1月至2015年12月我院收治的76例重症肺炎合并呼吸衰竭新生儿的临床资料,45例使用机械通气联合肺表面活性物质为观察组,31例单用机械通气为对照组,比较分析两组患儿的治疗效果、血气分析指标、乳酸水平、氧合指数、呼吸机参数、机械通气时间、吸氧时间、住院时间、并发症和转归等。结果:观察组治疗后第7天氧合指数为284.48±48.11,与对照组237.88±49.25比较差异有统计学意义(P<0.05)。观察组机械通气时间为(95.46±17.41)h、总吸氧时间为(96.61±18.09)h、住院时间为(21.30±4.60)h,对照组分别为(112.58±20.21)h、(116.72±28.11)h、(27.12±5.14)h(P<0.05)。观察组呼吸机相关肺炎(8.89%)、呼吸机相关肺损伤(2.22%)发生率低于对照组(29.03%、16.13%,P<0.05)。观察组和对照组气胸发生率(4.44%vs 3.23%)、肺出血的发生率(2.22%vs 6.45%)比较差异无统计学意义(P>0.05)。观察组存活率(95.56%)高于对照组(80.65%,P<0.05)。结论:机械通气联合肺表面活性物质可有效治疗新生儿重症肺炎合并呼吸衰竭,缓解临床症状,改善肺氧合功能,减少并发症和改善预后。
Objective: To study the clinical efficacy of mechanical ventilation combined with pulmonary surfactant in the treatment of neonatal severe pneumonia complicated with respiratory failure. Methods: The clinical data of 76 neonates with severe pneumonia and respiratory failure who were admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed. Among them, 45 cases were treated with mechanical ventilation combined with pulmonary surfactant as observation group and 31 cases with single mechanical Ventilation for the control group, comparative analysis of two groups of children with treatment, blood gas analysis indicators, lactic acid levels, oxygenation index, ventilator parameters, mechanical ventilation time, oxygen time, hospital stay, complications and outcome. Results: The oxygenation index of the observation group was 284.48 ± 48.11 on the 7th day after treatment, which was significantly different from that of the control group (237.88 ± 49.25) (P <0.05). The time of mechanical ventilation in the observation group was (95.46 ± 17.41) h, the total oxygen inhalation time was (96.61 ± 18.09) h, the hospitalization time was (21.30 ± 4.60) h in the observation group and (112.58 ± 20.21) h, ) h, (27.12 ± 5.14) h (P <0.05). The incidence of ventilator-associated pneumonia (8.89%) and ventilator-associated lung injury (2.22%) in the observation group was lower than that in the control group (29.03%, 16.13%, P <0.05). The incidence of pneumothorax (4.44% vs 3.23%) and incidence of pulmonary hemorrhage (2.22% vs 6.45%) in observation group and control group were not significantly different (P> 0.05). Survival rate of the observation group (95.56%) was higher than that of the control group (80.65%, P <0.05). Conclusion: Mechanical ventilation combined with pulmonary surfactant can effectively treat neonatal severe pneumonia with respiratory failure, relieve clinical symptoms, improve pulmonary oxygenation, reduce complications and improve prognosis.