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目的:评价大剂量氨溴索联合鼻塞/鼻罩持续气道正压通气(nCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法:将49例NRDS患儿随机分为治疗组25例和对照组24例,均给予温箱保暖、预防感染、纠正酸中毒、持续胃肠减压、静脉营养、呼吸道护理及监测生命体征等综合管理。两组均给予nCPAP治疗:选用Bubble CPAP system,根据鼻部大小选择鼻塞及鼻罩,鼻塞和鼻罩交替使用,每4 h更换1次,初始流量6~8 L,吸入氧浓度(FiO2)0.40~0.60,压力5~8 cm H2O,以后酌情调整;当FiO2<0.30、压力降至2 cm H2O,而氧分压(PaO2)保持在60~90 mm Hg、二氧化碳分压(PaCO2)<50 mm Hg、胸片明显好转时,改为头罩或鼻导管吸氧。治疗组入院即给予盐酸氨溴索30 mg/(kg·d)每日分4次用微量泵静脉输注,每次输注时间>5 min,连用5 d。比较两组疗效及氧合指标变化。结果:(1)治疗组总有效率92.0%,对照组75.0%,两组比较差异无统计学意义(P>0.05);(2)治疗组nCPAP上机时间、用氧时间、住院时间短于对照组(P<0.01);(3)从治疗后24 h开始,治疗组血气分析及氧合指标优于对照组(P<0.05)。结论:大剂量盐酸氨溴索联合nCPAP治疗NRDS效果优于单用nCPAP治疗,值得基层医院推广应用。
Objective: To evaluate the efficacy of high-dose ambroxol combined with nasal continuous nasal mask positive airway pressure (nCPAP) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: Forty-nine children with NRDS were randomly divided into treatment group (n = 25) and control group (n = 24). All patients were given warm incubator, infection prevention, acidosis correction, continuous gastrointestinal decompression, parenteral nutrition, respiratory care and monitoring of vital signs Integrated management. Nasal and nasal masks were selected according to the nasal size. Nasal and nasal masks were used interchangeably every 4 hours. The initial flow rate was 6 to 8 L and the FiO2 was 0.40 ~ 0.60 and pressure of 5 ~ 8 cm H2O, then adjust as appropriate; when FiO2 <0.30, the pressure drops to 2 cm H2O, and the PaO2 remains at 60-90 mm Hg, PaCO2 <50 mm Hg, chest radiograph significantly improved, replaced by hood or nasal catheter oxygen. Ambroxol hydrochloride 30 mg / (kg · d) was given to the treatment group on a daily basis by intravenous infusion of micro-pump four times a day for 5 minutes each for 5 days. The curative effect and changes of oxygenation index were compared between the two groups. Results: (1) The total effective rate was 92.0% in the treatment group and 75.0% in the control group. There was no significant difference between the two groups (P> 0.05). (2) The nCPAP time, oxygen time and hospital stay in the treatment group were shorter than (P <0.01). (3) From 24 h after treatment, the blood gas analysis and oxygenation index of the treatment group was better than that of the control group (P <0.05). CONCLUSION: High-dose ambroxol hydrochloride combined with nCPAP is superior to nCPAP in the treatment of NRDS, which is worth popularizing and applying in primary hospitals.