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目的对比不同方法纤维支气管镜肺泡灌洗治疗新生儿胎粪吸入综合征(MAS)的疗效,并探讨其可能的机制。方法选取2014年6月-2016年6月入住该院新生儿重症监护病房(NICU)确诊为MAS的患儿,随机分为稀释肺表面活性物质(PS)灌洗组、生理盐水(NS)灌洗组、未灌洗对照组。3组采用灌洗或气道内吸引后首剂气管内滴入PS 100 mg/kg,观察3组患儿治疗前后2、4、8、12、24、48、72 h氧合指数(OI)、P/F值、机械通气时间、肺部超声、住院时间、并发症发生率、治愈率、死亡率。结果 PS组与NS组在灌洗后4~12 h OI值和P/F值均差异有统计学意义(均P<0.05),12~72 h OI和P/F差异均无统计学意义(P>0.05);PS灌洗组和未灌洗组在各观察时段的OI和P/F与对照组差异均有统计学意义(P<0.05)。PS灌洗组和NS灌洗组与对照组比较,拔管时间、无创机械通气(NIPPV)持续时间,高流量给氧持续时间均缩短(P<0.05),需要高频支持的比率减少(P<0.05);PS灌洗组和NS灌洗组的PS使用总量和次数较对照组减少(P<0.05);PS灌洗组和NS灌洗组对比,以上观察指标差异无统计学意义(P>0.05)。PS灌洗组和NS灌洗组与对照组比较,肺气漏、感染性肺炎、呼吸机相关肺炎(VAP)、合并持续肺动脉高压(PPHN)、急性呼吸窘迫综合征(ARDS)的比率减少,差异均有统计学意义(P<0.05)。PS灌洗组与NS灌洗组与对照组的死亡率和放弃率比较,明显减少,差异有统计学意义(P<0.05);PS灌洗组和NS灌洗组比较,以上观察指标差异无统计学意义(P>0.05)。结论气管内滴入PS治疗MAS的疗效肯定,早期纤维支气管镜肺泡灌洗的疗效明显优于未灌洗组,早期稀释PS灌洗与NS灌洗的疗效无差异。
Objective To compare the curative effects of different methods of bronchoscopic alveolar lavage on neonatal meconium aspiration syndrome (MAS) and to explore its possible mechanism. Methods From June 2014 to June 2016, infants diagnosed with MAS with neonatal intensive care unit (NICU) admitted to the hospital were randomly divided into three groups: diluted lung surfactant (PS) group, saline (NS) group Wash group, no lavage control group. Three groups were given PS 100 mg / kg intratracheally after lavage or intratracheal instillation. Oxygenation index (OI) at 2, 4, 8, 12, 24, 48, / F value, mechanical ventilation time, pulmonary ultrasound, length of stay, complication rate, cure rate, and mortality. Results There were significant differences in OI and P / F between 4 h and 12 h after lavage in PS group and NS group (all P <0.05). There was no significant difference in OI and P / F between 12 and 72 h P> 0.05). The differences of OI and P / F between PS lavage group and non-lavage group and control group were statistically significant (P <0.05). Compared with the control group, the duration of extubation, duration of NIPPV and duration of hyperbaric oxygen administration were shorter in PS lavage group and NS lavage group (P <0.05) <0.05). The total amount and frequency of PS use in PS lavage group and NS lavage group were lower than those in control group (P <0.05). There was no significant difference in the above indexes between PS lavage group and NS lavage group P> 0.05). Compared with the control group, the rates of pneumoconiosis, infectious pneumonia, ventilator-associated pneumonia (VAP), combined persistent pulmonary hypertension (PPHN) and acute respiratory distress syndrome (ARDS) in PS lavage group and NS lavage group were decreased, The differences were statistically significant (P <0.05). PS lavage group and NS lavage group and control group mortality and abandonment rate was significantly reduced, the difference was statistically significant (P <0.05); PS lavage group and NS lavage group, the above indicators were no difference Statistical significance (P> 0.05). Conclusions The efficacy of intratracheal instillation of PS in the treatment of MAS is positive. The efficacy of early bronchofibroscopic alveolar lavage is better than that of the non-lavage group. There is no difference in the efficacy between early PS lavage and NS lavage.