药物三联法治疗极低出生体质量儿支气管肺发育不良的疗效及随访

    Curative effects and follow-up of the drug triple therapy in the treatment of bronchopulmonary dysplasia in infants with very low birth weight

    • 摘要:
      目的分析药物三联法治疗极低出生体质量儿支气管肺发育不良的疗效及远期随访结果。
      方法244例极低出生体质量(体质量 < 1 500g)伴支气管肺发育不良患儿,入院时均接受气管插管有创机械通气,将接受布地奈德+肺表面活性物质治疗的120例纳入对照组,将接受布地奈德+肺表面活性物质+维生素A治疗的124例纳入观察组。比较2组疗效、再就诊率、呼吸能力恢复时间、血气分析及氧合指数、治疗期间并发症。随访2年,分析2组患儿1岁、2岁时肺功能。
      结果观察组治疗总有效率91.94%(114/124),高于对照组的78.33%(94/120)(P < 0.01);再就诊率7.26%(9/124),低于对照组的18.33%(22/120)(P < 0.01);治疗期间并发症总发生率3.23%(4/124),低于对照组的15.00%(18/120)(P < 0.01);观察组吸氧时间、机械通气时间、住院时间均比对照组短(P < 0.01),呼吸频率比对照组低(P < 0.01);治疗2个疗程后的动脉血氧分压、pH值、氧合指数均比对照组高(P < 0.01),动脉二氧化碳分压比对照组低(P < 0.01);观察组1岁、2岁吸气时间、达峰容积比、达峰时间比比对照组高(P < 0.01),呼气时间比对照组低(P < 0.01)。
      结论极低出生体质量伴支气管肺发育不良患儿实施药物三联法疗效显著,可调节患儿血气分析及氧合指数,促进呼吸能力快速恢复,改善预后肺功能指标,且治疗期间并发症少,安全性高。

       

      Abstract:
      ObjectiveTo analyze the efficacy and long-term follow-up results of the drug triple thrapy in the treatment of bronchopulmonary dysplasia in very low birth weight infants.
      MethodsThe clinical data of 244 children with very low birth weight(body mass < 1 500 g) complicated with bronchopulmonary dysplasia were retrospectively analyzed.All patients were treated with invasive mechanical ventilation through endotracheal intubation at admission.One hundred and twenty children treated with budesonide combined with pulmonary surfactant and 124 children treated with budesonide pulmonary surfactant, combined with vitamin A were divided into the control group and observation group, respectively.The differences of the therapeutic effect, revisit rate, recovery time of respiratory capacity, blood gas analysis and oxygenation index and complications during treatment were compared between two groups.The patients were followed up for 2 years, and the lung function in two groups was analyzed at 1 and 2 years of age.
      ResultsThe total effective rate in the observation group was 91.94%(114/124), which was higher than that in control group(78.33%, 94/120)(P < 0.01);the rate of revisiting in the observation group was 7.26%(9/124), which was lower than 18.33%(22/120) of the control group(P < 0.01), and the total incidence rate of complications during treatment in the observation group was 3.23%(4/124), which was lower than 15.00%(18/120) of the control group(P < 0.01).The time of oxygen inhalation, mechanical ventilation and hospital stay in observation group were shorter than those in control group(P < 0.01), and the respiratory rate in observation group was lower than that in control group(P < 0.01).After two courses of treatment, the arterial partial pressure of oxygen, pH value and oxygenation index in observation group were higher than those in control group(P < 0.01), and the arterial partial pressure of carbon dioxide in observation group was lower than that in control group(P < 0.01).The inspiratory time, peak volume ratio and peak time ratio in observation group were higher than those in control group at 1 and 2 years old(P < 0.01), while the expiratory time in observation group was lower than that in control group(P < 0.01).
      ConclusionsThe effects of drug triple therapy in the treatment of children with very low birth weight complicated bronchopulmonary dysplasia is significant, which can adjust the blood gas analysis and oxygenation index, promote the rapid recovery of respiratory capacity, improve the prognostic pulmonary function indexes, and have fewer complications and high safety during the treatment.

       

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