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目的探讨肺表面活性物质(PS)治疗肺内源性与肺外源性新生儿急性肺损伤(ALI)的治疗效果。方法选择2010年6月至2012年9月本院新生儿科收治的ALI患儿,按病因分为肺源性组与肺外源性组,均予以肺保护性通气策略机械通气以及PS气管插管内注入,在PS治疗前后监测肺顺应性以及氧合指数(OI),分析两组患儿的治疗及预后。结果使用PS前,肺源性组(21例)肺顺应性低于肺外源性组(31例)[(0.23±0.09)比(0.34±0.12),P<0.05];使用PS后,两组肺顺应性改善明显,均先增高,后逐步回落;使用PS后2、24、48 h肺外源性组肺顺应性均高于肺源性组[2 h:(0.60±0.21)比(0.35±0.16),24 h:(0.54±0.18)比(0.28±0.13),48 h:(0.55±0.12)比(0.29±0.17),P<0.05];两组患儿OI在使用PS后均明显改善,使用后2、24、48 h肺外源性组明显低于肺源性组[2 h:(15.1±2.8)比(20.3±3.9),24 h:(18.4±4.2)比(25.2±5.3),48 h:(10.4±5.6)比(16.4±4.4),P<0.05]。肺源性组机械通气时间、住院时间均长于肺外源性组,病死率高于肺外源性组(P<0.05)。结论新生儿肺源性与肺外源性ALI存在肺顺应性的差异;肺外源性ALI对PS治疗的反应优于肺源性ALI。
Objective To investigate the therapeutic effect of pulmonary surfactant (PS) on pulmonary endogenous and extra-pulmonary neonatal acute lung injury (ALI). Methods From June 2010 to September 2012, neonates with ALI admitted to neonatology department of our hospital were divided into lung-derived group and exogenous lung group by etiological factor. All patients underwent lung protective ventilation strategy mechanical ventilation and PS tracheal intubation The lung compliance and oxygenation index (OI) were monitored before and after PS treatment, and the treatment and prognosis of the two groups were analyzed. Results Before PS, lung compliance in lung-derived group (21 cases) was lower than that in lung-derived group (31 cases) (0.23 ± 0.09 vs 0.34 ± 0.12, P <0.05) The pulmonary compliance improved obviously, and then increased gradually and then gradually decreased. The lung compliance of pulmonary extracorporeal group at 2, 24 and 48 h after PS administration was higher than that of pulmonary group [2 h: (0.60 ± 0.21) vs 0.35 ± 0.16), 24 h: (0.54 ± 0.18) vs (0.28 ± 0.13), 48 h: (0.55 ± 0.12) vs (0.29 ± 0.17), P <0.05; (2 h: (15.1 ± 2.8) vs (20.3 ± 3.9), 24 h: (18.4 ± 4.2) vs (25.2 ± 5.3), 48 h: (10.4 ± 5.6) vs (16.4 ± 4.4), P <0.05]. The pulmonary ventilation group had longer duration of mechanical ventilation and longer hospital stay than the exogenous pulmonary group, and the mortality was higher than that of pulmonary exogenous group (P <0.05). Conclusions There is a difference in lung compliance between newborns with pulmonary ALI and pulmonary ALI. The exogenous ALI is superior to pulmonary ALI in response to PS.