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目的:探讨重症胎粪吸入综合征(MAS)的有效治疗方法。方法:选取2004年9月至2014年12月河南省平顶山市妇幼保健院新生儿科治疗的重症MAS患儿64例,按治疗方案分为高频振荡通气(HFOV)+肺表面活性物质(PS)组、常频机械通气(CMV)+PS组、HFOV组、CMV组各16例,4组辅助处理措施相同。PS为注射用牛肺表面活性剂(Calsurf),在气管插管后以100 mg/kg气管内给药,患儿依次取平卧位、左侧卧位、右侧卧位、平卧位,每个体位均注入总剂量的1/4,为防止药物黏滞导致气道阻塞,给药时采用复苏囊加压通气,给药完毕后继续给予呼吸机辅助通气。观察记录4组患儿治疗前后不同时间点的血气分析、Pa O2/Fi O2、氧合指数(OI)及机械通气时间、住院时间、转归情况。结果:HFOV+PS组死亡2例,CMV+PS组死亡3例,HFOV组死亡3例,CMV组死亡4例,其他患儿均治愈出院,4组患儿的转归情况比较差异无统计学意义(P>0.05)。4组患儿治疗前(0 h)p H、Pa O2、Pa CO2、Pa O2/Fi O2、OI比较差异无统计学意义(P>0.05),均随着治疗时间的延长而逐渐改善,其中HFOV+PS组改善最为显著,其在治疗2、12、24、48 h时与另3组比较差异均有统计学意义(P均<0.05)。HFOV+PS组的平均机械通气时间为(93.6±41.2)h,平均住院时间为(15.8±5.1)d,均短于其余3组(P均<0.05)。结论:HFOV联合PS治疗重症MAS,可迅速改善通气和氧合功能,缩短机械通气时间和住院时间,值得临床推广应用。
Objective: To explore the effective treatment of severe meconium aspiration syndrome (MAS). Methods: Sixty-four cases of severe MAS children treated by neonatology at Pingdingshan Maternal and Child Health Hospital of Henan Province from September 2004 to December 2014 were divided into high frequency oscillatory ventilation (HFOV) + pulmonary surfactant (PS) Group, CMV + PS group, HFOV group and CMV group. Each group had the same auxiliary treatment measures. PS was injected bovine pulmonary surfactant (Calsurf), tracheal intubation with 100 mg / kg intratracheal administration, children followed by supine, left lateral position, right lateral position, supine position, Each position were infused with a total dose of 1/4, in order to prevent drug stickiness lead to airway obstruction, the use of recovery capsule pressure ventilation, continue to give ventilation after ventilator assisted. Blood gas analysis, Pa O2 / Fi O2, oxygenation index (OI) and mechanical ventilation time, hospitalization time and outcome were recorded and recorded at 4 different time points before and after treatment. Results: There were 2 deaths in HFOV + PS group, 3 deaths in CMV + PS group, 3 deaths in HFOV group and 4 deaths in CMV group. All the other children were cured and discharged. There was no significant difference in the outcome among 4 groups Significance (P> 0.05). There was no significant difference in p H, Pa O2, Pa CO2, Pa O2 / Fi O2 and OI between the 4 groups before treatment (0 h) (P> 0.05), all of which improved gradually with the prolongation of treatment time HFOV + PS group showed the most significant improvement. The difference was statistically significant (P <0.05) between the two groups at 2, 12, 24, and 48 h after treatment. The average duration of mechanical ventilation in HFOV + PS group was (93.6 ± 41.2) h, and the average hospital stay was (15.8 ± 5.1) days, both of which were shorter than the other three groups (all P <0.05). Conclusion: The treatment of severe MAS with HFOV combined with PS can rapidly improve the ventilation and oxygenation function, shorten the duration of mechanical ventilation and hospital stay, and is worthy of clinical application.