摘要
目的比较矛头蝮蛇血凝酶联合高频震荡通气(HFOV)与联合同步间歇指令通气(SIMV)治疗新生儿肺出血(NPH)的临床疗效。方法选择2018年8月至2020年8月新乡医学院附属濮阳市油田总医院收治的78例NPH患儿为研究对象。根据治疗方法将患儿分为对照组与观察组,每组39例。对照组和观察组患儿在常规治疗基础上分别使用呼吸机SIMV、HFOV模式治疗,2组患儿在使用呼吸机过程中均使用注射用矛头蝮蛇血凝酶。比较2组患儿肺出血停止时间、呼吸机使用时间、住院时间。分别于治疗前后使用呼吸机检测2组患儿的呼吸频率(RR)、潮气量(VT)、吸气峰压(PIP)、呼吸系统顺应性(Crs)。分别于治疗前后抽取2组患儿动脉血2 mL,使用血气分析仪检测患儿动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))、氧合指数(OI)。治疗期间及治疗结束后1个月内,统计2组患儿病死情况及并发症发生情况,并计算2组病死率和总并发生发生率。结果观察组患儿的肺出血停止时间、呼吸机使用时间、住院时间均显著短于对照组(P<0.05)。治疗前和治疗后,对照组与观察组患儿的RR、VT、PIP、Crs比较差异无统计学意义(P>0.05);2组患儿治疗后的RR、PIP显著低于治疗前,VT、Crs显著高于治疗前(P<0.05)。治疗前,2组患儿的PaCO_(2)、PaO_(2)、SaO_(2)、OI比较差异无统计学意义(P>0.05);2组患儿治疗后的PaCO_(2)显著低于治疗前,PaO_(2)、SaO_(2)、OI显著高于治疗前(P<0.05);治疗后,观察组患儿的PaCO_(2)显著低于对照组,PaO_(2)、SaO_(2)、OI显著高于对照组(P<0.05)。对照组和观察组患儿的病死率分别为20.51%(8/39)和15.38%(6/39),2组患儿病死率比较差异无统计学意义(χ^(2)=0.348,P>0.05)。对照组和观察组患儿的总并发症发生率分别为33.33%(13/39)和10.26%(4/39),观察组患儿总并发症发生率显著低于对照组(χ^(2)=6.093,P<0.05)。结论HFOV或SIMV联合矛头蝮蛇血凝酶治疗NPH均显示出良好效果,HFOV联合矛头蝮蛇血凝酶在缩短患儿病程、改善患儿血气指标及减少并发症方面效果更显著。
Objective To compare the clinical efficacy of hemocoagulase bothrops atrox combined with high frequency oscillatory ventilation(HFOV)and hemcoagulas bothrops atrox combined with synchronized intermittent mandatory ventilation(SIMV)in the treatment of neonatal pulmonary hemorrhage(NPH).Methods A total of 78 children with NPH admitted to the Puyang Oilfield General Hospital Affiliated to Xinxiang Medical University from August 2018 to August 2020 were selected as the research objects.According to the treatment method,the children were divided into the control group and the observation group,with 39 cases in each group.On the basis of conventional treatment,the children in the control group and the observation group were treated with SIMV and HFOV modes of ventilator,respectively.The patients in the two groups were treated with hemocoagulase bothrops atrox for injection during the use of the ventilator.The cessation time of pulmonary hemorrhage,the use time of ventilator and the hospitalization time of children were compared between the two groups.The respiratory rate(RR),tidal volume(VT),peak inspiratory pressure(PIP)and compliance of the respiratory system(Crs)of the children in the two groups were detected by the ventilator before and after treatment.Before and after treatment,2 mL of arterial blood was drawn from the children in the two groups,and the partial pressure of carbon dioxide in artery(PaCO_(2)),partial pressure of oxygen(PaO_(2)),oxygen saturation(SaO_(2))and oxygenation index(OI)were detected by the blood gas analyzer.During the treatment period and within 1 month after treatment,the mortality and complications of children in the two groups were counted,and the mortality rate and the incidence of total complications were calculated in the two groups.Results The cessation time of pulmonary hemorrhage,the use time of ventilator and the hospitalization time of children in the observation group were significantly shorter than those in the control group(P<0.05).Before and after treatment,there was no significant difference in the RR,VT,PIP and Crs of children between the two groups(P>0.05);the RR and PIP of children after treatment were significantly lower than those before treatment,and the VT and Crs were significantly higher than those before treatment in the two groups(P<0.05).There was no significant difference in the PaCO_(2),PaO_(2),SaO_(2) and OI of children between the two groups before treatment(P>0.05);the PaCO_(2) of children in the two groups after treatment was significantly lower than that before treatment,and the PaO_(2),SaO_(2) and OI were significantly higher than those before treatment(P<0.05);after treatment,the PaCO_(2) of children in the observation group were significantly lower than that in the control group,and the PaO_(2),SaO_(2) and OI were significantly higher than those in the control group(P<0.05).The mortality rate of children in the control group and observation group was 20.51%(8/39)and 15.38%(6/39),respectively;there was no significant difference in the mortality rate of children between the two groups(χ^(2)=0.348,P>0.05).The incidence of total complications of children in the control group and the observation group was 33.33%(13/39)and 10.26%(4/39);the incidence of total complications in the observation group was significantly lower than that in the control group(χ^(2)=6.093,P<0.05).Conclusion HFOV or SIMV combined with hemocoagulase bothrops atrox showed good effect in the treatment of NPH,and HFOV combined with hemocoagulase bothrops atrox was more effective in shorting the course of disease,improving blood gas indexes and reducing the complications of children with NPH.
作者
陈秋芳
和俊杰
刘雪杰
CHEN Qiufang;HE Junjie;LIU Xuejie(Department of Pediatrics,Puyang Oilfield General Hospital Affiliated to Xinxiang Medical University,Puyang 457001,Henan Province,China)
出处
《新乡医学院学报》
CAS
2022年第7期664-668,共5页
Journal of Xinxiang Medical University
关键词
肺出血
新生儿
高频振荡通气
同步间歇指令通气
矛头蝮蛇血凝酶
pulmonary hemorrhage
newborn
high frequency oscillatory ventilation
synchronized intermittent mandatory ventilation
hemocoagulase bothrops atrox
