Clinical Application Of Glucocorticoid Inhalation For Ventilator-associated Pneumonia In Premature Infants

Objective:On the basis of conventional treatment,this study aimed to investigate the effect of glucocorticoid inhalation on pulmonary oxygenation,diseases course and complication in premature infants with ventilator-associated pneumonia?VAP?,thereby evaluating the clinical value of glucocorticoid inhalation.Methods:In this study,seventy premature infants?gestational age<32 W?diagnosed with VAP from April 2018 to March 2019 in the neonatal intensive care unit of Ganzhou People's Hospital were collected.These infants were randomly divided into experimental group and control group,35 cases in each group,all of them had neonatal respiratory distress syndrome?NRDS?,and received mechanical ventilation>48 h.The general information of infants was recorded,including gender,gestational age,birth weight,delivery mode,and application of prenatal glucocorticoids.The PaO₂,PaCO₂ and OI were analyzed before treatment and after treatment?1 d,2 d,3 d and 7 d?,moreover,withdrawal rate of 7 days after treatment,total oxygen intake time,hospitalization days,complications between two groups were compared,as well as total therapeutic efficiency.SPSS 20.0 software was used for statistical analysis.The measurement data were expressed as mean±standard deviation??x±SD?,the independent-samples T test was used for data comparison between groups.The chi-square test was used for counting data.P<0.05 was considered as statistically significant.Result:1.The data of PaO₂,PaCO₂ and OI between two groups before treatments show no significant different?P>0.05?.Compared with before treatment,the data of PaCO₂and OI after treatments was decreased in two groups,while the data of PaO₂ was increased.PaO₂ in the experimental group was higher than that in the control group at1 d,2 d and 3 d after treatment,while PaCO₂,OI was lower than that in the control group at 1 d,2 d and 3 d after treatment,all the differences were statistically significant?P<0.05?.There was no statistically significant difference in PaO₂ and PaCO₂ between two groups on 7 d after treatment?P>0.05?.However,the OI data of the experimental group were lower than the control group on 7 d after treatment,with statistically significant differences?P<0.05?.2.The treatment efficiency in the two groups was compared,the withdrawal rate of 7 d after treatment and the total efficiency of the experimental group was higher than that of the control group,with statistically significant differences?P<0.05?.3.Compared with the control group,the total oxygen intake time and hospitalization days were significantly shortened,with statistically significant differences?P<0.05?.4.Complications during treatment were compared:there was no statistical difference of complications between the experimental group and the control group,including patent ductus arteriosus,persistent pulmonary hypertension of the newborn and intracranial hemorrhage?P>0.05?.However,the incidence of bronchopulmonary dysplasia in experimental group was significantly lower than that in the control group,with statistically significant differences?P<0.05?.Conclusion:1.The data of PaO₂,PaCO₂ and OI were significantly improved after glucocorticoid inhalation treating premature infants with VAP,which suggested that it can quickly treat hypoxemia,reduce carbon dioxide retention,lower mean airway pressure,increase alveolar compliance,and effectively improve pulmonary oxygenation and ventilation.2.The treatment of glucocorticoid inhalation improve the clinical symptoms,vital signs and lung images,it increased the treatment effectiveness,and improve the withdrawal rate of 7 d and the total efficiency after treatment,as well as total oxygen time,hospitalization days,suggesting glucocorticoid inhalation can shorten the disease course of premature infants with VAP,and be beneficial to the recovery.3.The treatment of glucocorticoid inhalation cannot increased the complications,such as patent ductus arteriosus,persistent pulmonary hypertension of the newborn,intracranial hemorrhage,interestingly,it had effect on BPD progress of premature infants,it significantly decreased the incidence of BPD,our results suggested that early addition of glucocorticoid inhalation can reduce BPD risk in infants with VAP.