[1]陈秋芳,和俊杰,刘雪杰.矛头蝮蛇血凝酶联合高频振荡通气与联合同步间歇指令通气治疗新生儿肺出血疗效比较[J].新乡医学院学报,2022,39(7):664-668.[doi:10.7683/xxyxyxb.2022.07.013]
　CHEN Qiufang,HE Junjie,LIU Xuejie.Comparison of curative effect of hemocoagulase bothrops atrox combined with high frequency oscillatory ventilation and combined with synchronous intermittent mandatory ventilation in the treatment of neonatal pulmonary hemorrhage[J].Journal of Xinxiang Medical University,2022,39(7):664-668.[doi:10.7683/xxyxyxb.2022.07.013]
点击复制

矛头蝮蛇血凝酶联合高频振荡通气与联合同步间歇指令通气治疗新生儿肺出血疗效比较
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年7
页码:
664-668
栏目:
临床研究
出版日期:
2022-07-05

文章信息/Info

Title:
Comparison of curative effect of hemocoagulase bothrops atrox combined with high frequency oscillatory ventilation and combined with synchronous intermittent mandatory ventilation in the treatment of neonatal pulmonary hemorrhage
作者:
陈秋芳; 和俊杰; 刘雪杰
（新乡医学院附属濮阳市油田总医院儿科，河南　濮阳　457001）
Author(s):
CHEN Qiufang; HE Junjie; LIU Xuejie
（Department of Pediatrics,Puyang Oilfield General Hospital Affiliated to Xinxiang Medical University,Puyang 457001，Henan Province,China）
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
Keywords:
pulmonary hemorrhage; newborn; high frequency oscillatory ventilation; synchronized intermittent mandatory ventilation; hemocoagulase bothrops atrox
分类号:
R722.15
DOI:
10.7683/xxyxyxb.2022.07.013
文献标志码:
A
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（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、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PaCO2、PaO2、SaO2、OI比较差异无统计学意义（P>0.05）；2组患儿治疗后的PaCO2显著低于治疗前，PaO2、SaO2、OI显著高于治疗前（P<0.05）；治疗后，观察组患儿的PaCO2显著低于对照组，PaO2、SaO2、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（χ2=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（χ2=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。
Abstract:
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 (PaCO2),partial pressure of oxygen (PaO2),oxygen saturation (SaO2) 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 PaCO2,PaO2,SaO2 and OI of children between the two groups before treatment (P>0.05);the PaCO2 of children in the two groups after treatment was significantly lower than that before treatment,and the PaO2,SaO2 and OI were significantly higher than those before treatment (P<0.05);after treatment,the PaCO2 of children in the observation group were significantly lower than that in the control group,and the PaO2,SaO2 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 (χ2=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 (χ2=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.

参考文献/References:

［1］　LEE M,WU K,YU A,et al.Pulmonary hemorrhage in neonatal respiratory distress syndrome:radiographic evolution,course,complications and long-term clinical outcomes［J］.J Neonatal Perinatal Med,2019,12(2):161-171.
［2］　WU R,TIAN Z F,ZHENG G F,et al.Treatment of neonates with meconium aspiration syndrome by proportional assist ventilation and synchronized intermittent mandatory ventilation:a comparison study［J］.Minerva Pediatr,2016,68(4):262-268.
［3］　SNCHEZ-LUNA M,GONZLEZ-PACHECO N,BELIK J,et al.New ventilator strategies:high-frequency oscillatory ventilation combined with volume guarantee［J］.Am J Perinatol,2018,35(6):545-548.
［4］　潘维伟,童笑梅.2007～2016年10年间早产儿肺出血的治疗与预后分析［J］.中国当代儿科杂志,2018,20(4):255-260.
PAN W W,TONG X M.Treatment and prognosis of pulmonary hemorrhage in preterm infants during 2007-2016［J］.Chin J Contemp Pediatr,2018,20(4):255-260.
［5］　姬婷婷,史桂梅,姜鸿,等.蛇毒矛头蝮蛇血凝酶治疗新生儿上消化道出血临床疗效及对凝血功能的影响研究［J］.中国临床医生杂志,2018,46(3):362-364.
JI T T,SHI G M,JIANG H,et al.Clinical efficacy of snake venom hemagglutinase in the treatment of neonatal upper gastrointestinal bleeding and the effect on coagulation function［J］.Chin J Clin,2018,46(3):362-364.
［6］　邵肖梅,叶鸿瑁,丘小汕.实用新生儿学［M］.北京:人民卫生出版社,2010:408-410.
SHAO X M,YE H M,QIU X S.Practice of neonatology［M］.Beijing:People′s Medical Publishing House,2010:408-410.
［7］　叶武成,叶鹏,贺波.首选高频振荡通气治疗新生儿肺出血的有效性及安全性［J］.临床和实验医学杂志,2016,15(15):1542-1544.
YE W C,YE P,HE B.Study on the efficacy and safety of preferred high-frequency oscillatory ventilation in treatment of neonatal pulmonary hemorrhage［J］.J Clin Exp Med,2016,15(15):1542-1544.
［8］　SU B H,LIN H Y,HUANG F K,et al.Circulatory management focusing on preventing intraventricular hemorrhage and pulmonary hemorrhage in preterm infants［J］.Pediatr Neonatol,2016,57(6):453-462.
［9］　黄文卿,张巍,马建荣.早产儿肺出血高危因素的临床研究［J］.中国优生与遗传杂志,2020,28(6):726-728,735.
HUANG W Q,ZHANG W,MA J R.Clinical study on the risk factors of pulmonary hemorrhage in premature infants［J］.Chin J Birth Health Heredity,2020,28(6):726-728,735.
［10］　刘鸽,田秀英,张婉娴.NICU中新生儿肺出血的高危因素及策略分析［J］.实用心脑肺血管病杂志,2019,27(S2):107-109.
LIU G,TIAN X Y,ZHANG W X.Analysis of high risk factors and strategies for neonatal pulmonary hemorrhage in the NICU［J］.PJCCPVD,2019,27(S2):107-109.
［11］　OMANSKY G L.Pulmonary hemorrhage in the neonate［J］.Neonatal Netw,2019,38(2):109-112.
［12］　MIAO J,XIE H,ZHANG Y,et al.Continuous positive pressure ventilation combined with pulmonary surfactant in the treatment of neonatal respiratory distress syndrome［J］.Pak J Med Sci,2020,36(4):647-651.
［13］　赵朋飞.机械通气联合不同途径止血药治疗新生儿肺出血的疗效评估［J］.泰山医学院学报,2017,38(9):1064-1065.
ZHAO P F.Evaluation of the efficacy of mechanical ventilation combined with different routes of hemostatic drugs in the treatment of pulmonary hemorrhage in neonates［J］.J Taishan Med Coll,2017,38(9):1064-1065.
［14］　GREENOUGH A,ROSSOR T E,SUNDARESAN A,et al.Synchronized mechanical ventilation for respiratory support in newborn infants［J］.Cochrane Database Syst Rev,2016,9(9):CD000456.
［15］　姚和平,徐培林,王英英.同步间歇指令通气对呼吸衰竭新生儿血气指标的影响［J］.中国医药导报,2018,15(13):72-75.
YAO H P,XU P L,WANG Y Y.Effect of synchronized intermittent mandatory ventilation on blood gas indexes in neonates with respiratory failure［J］.Chin Med Her,2018,15(13):72-75.
［16］　HAO L X,WANG F.Effectiveness of high-frequency oscillatory ventilation for the treatment of neonatal meconium aspiration syndrome［J］.Medicine (Baltimore),2019,98(43):e17622.
［17］　曹亚芹,董玉斌,张艳华,等.高频振荡通气治疗新生儿胎粪吸入综合征临床疗效分析［J］.临床肺科杂志,2018,23(1):175-177.
CAO Y Q,DONG Y B,ZHANG Y H,et al.Clinical efficacy analysis of high-frequency oscillatory ventilation for neonatal meconium aspiration syndrome［J］.J Clin Pulmon Med,2018,23(1):175-177.
［18］　MAT NOR M B,MD RALIB A,IBRAHIM N A,et al.High frequency oscillatory ventilation in leptospirosis pulmonary hemorrhage syndrome:a case series study［J］.Indian J Crit Care Med,2016,20(6):342-348.
［19］　叶梅玲,周彩玲,王灵华,等.新生儿肺出血预后危险因素分析［J］.中国妇幼健康研究,2018,29(8):962-965.
YE M L,ZHOU C L,WANG L H,et al.Analysis of prognostic risk factors of neonatal pulmonary hemorrhage［J］.Chin J Woman Child Health Res,2018,29(8):962-965.
［20］　廖沛光,伍静.高频振荡与同步间歇指令通气治疗新生儿呼吸窘迫综合征的比较分析［J］.临床急诊杂志,2019,20(3):235-238.
LIAO P G,WU J.Comparative analysis of high frequency oscillation and synchronous intermittent mandatory ventilation in the treatment of neonatal respiratory distress syndrome［J］.J Clin Emer,2019,20(3):235-238.
［21］　GANGULY A,MAKKAR A,SEKAR K.Volume targeted ventilation and high frequency ventilation as the primary modes of respiratory support for elbw babies:what does the evidence say［J］.Front Pediatr,2020,8:27.
［22］　HERRMANN J,LILITWAT W,TAWHAI M H,et al.High-frequency oscillatory ventilation and ventilator-induced lung injury:size does matter［J］.Crit Care Med,2020,48(1):e66-e73.

相似文献/References:

[1]刘素琴,徐晓群,徐苏东,等.妊娠期肝内胆汁淤积症对新生儿相关疾病发生情况的影响[J].新乡医学院学报,,():000.
[2]高锦荣,田玉慧,李万里,等.4659例新生儿出生体重的调查分析[J].新乡医学院学报,1986,3(03):017.
[3]冀玉英,冯淑英,王光松,等.新生儿败血症78例临床分析[J].新乡医学院学报,1987,4(03):052.
[4]于贵珍,杨平.新生儿溺入粪缸30分钟抢救成活一例[J].新乡医学院学报,1988,5(02):084.
[5]钱惠茵,李俊英,朱风华,等.347例新生儿死亡原因分析[J].新乡医学院学报,1989,6(02):109.
[6]陈莹,支凌翔,刘根生,等.新生儿胃肠道穿孔[J].新乡医学院学报,1994,11(03):294.
[7]杨立俭,田玉慧,高锦荣,等.分娩孕妇全血头发及新生儿脐血羊水中锌铜铁硒含量的研究[J].新乡医学院学报,1995,12(01):009.
[8]路永新,申素芳,赵润清,等.新生儿窒息的ABCDE复苏方案与预后[J].新乡医学院学报,1997,14(03):290.
[9]段金云,王柏霞.高危新生儿早期监测治疗[J].新乡医学院学报,1997,14(03):299.
[10]杨广平,州玉荣,王振西,等.5166例新生儿出生情况分析[J].新乡医学院学报,2001,18(06):439.

更新日期/Last Update: 2022-07-05