预防性应用表面活性剂对新生儿呼吸窘迫综合征防治的研究  

Protective and curative effects of prophylactic administration of pulmonary surfactant on neonatal respiratory distress syndrome

作　　者：初桂兰[1] 王静[1] 辛玥[1] 郑军[2] 郑荣秀[1] 毕道濯[1] 

机构地区：[1]天津医科大学总医院儿科,天津300052 [2]天津医科大学第二附属医院

出　　处：《中华医学杂志》2006年第13期876-880,共5页National Medical Journal of China

基　　金：天津市自然科学基金资助项目(033606311)

摘　　要：目的探讨预防性应用肺表面活性剂(PS)对新生儿呼吸窘迫综合征(NRDS)的防治效果。方法选取100例出生体重<1500 g,胎龄<32周,生后0.5 h内高危早产儿。预防应用PS前无呼吸窘迫综合征(RDS)临床及胸片表现。行胃液稳定微泡试验,微泡数<7个/mm2。随机分为预防组及非预防组,各50例。预防组入院后立即给予固尔苏。非预防组在发生RDS后再给予PS治疗。结果与给药前相比,RDS患儿在给药后1 h动脉氧分压(PaO2)、动脉/肺泡氧分压(a/APO2)、pH、动脉氧分压/吸入氧气浓度(PaO2/F iO2)明显上升,而动脉二氧化碳分压(PaCO2)明显下降(86.2mm Hg±8.1 mm Hg、0.30±0.04、7.38±0.06、178±37、37.3 mm Hg±9.8 mm Hg比45.8 mm Hg±10.4 mm Hg、0.12±0.02、7.18±0.09、63±16、53.6 mm Hg±11.1 mm Hg,P均<0.01),给药后6 h胸部X线片表现也明显改善(1.89分±0.34分比3.02分±0.23分,P<0.01)。接受机械通气的患儿在给药后F iO2及平均气道压(MAP)均较用药前明显下降(6.0 cm H2O±0.3 cmH2O比9.0 cm H2O±1.0 cm H2O,P均<0.05)。预防组RDS的发生率较非预防组为低(30%与64%,χ2=6.032,P<0.01)、重症发生率与病死率也明显降低(分别为20%与53%、0%与25%)(χ2=6.741,P=0.01;χ2=4.519,<0.05)。预防组RDS病人的总机械通气时间、需氧时间及住院时间也均明显短于非预防组(3.6 d±1.7 d比5.9 d±3.6 d,t=4.692,P<0.05;8.6 d±5.5 d比14.1 d±6.2 d,t=4.35,P<0.01;20.5 d±10.0 d比32.8 d±17.8 d,t=2.952,P<0.05)。结论PS替代治疗能改善NRDS患儿的肺换气功能。对具有发生NRDS高危儿预防性补充PS可降低RDS发生率、减轻RDS的严重程度及降低死亡率,减少并发症。Objective To evaluate the protective and curative effects of prophylactic administration of pulmonary surfactant （PS） on neonatal respiratory distress syndrome （NRDS）. Methods One hundred neonates aged 0.5 h after birth, with the gestational age 〈32 w, birth weight 〈 1500 g, and number of gastric, stable microbubble≤ 7/mm^2 by gastric stable microbubble test （SMT）, but without clinical or radiological manifestations of RDS at the admission, were randomly divided into 2 equal groups ： prophylactic group （ PG）, receiving curosurf, a product of PS, immediately after admission ; and nonprophylactic group （N-PG） , receiving curosurf only after development of RDS. Results One hour after the administration of PS, the PaO2 ,a/APO2 ,pH, and PaO2 of the PG group were 86.2 mm Hg ± 8.1 mm Hg, 0.30 ± 0.04, 7. 38 ±0.06, and 178 ±37, all significantly higher than those of the non-PG group （all P〈0.01）, and the PaCO2 of the PG group was 37.3 mm Hg ± 9.8 mm Hg, significantly lower than that of the non-PG group （53.6 mm Hg ± 11.1 mm Hg, P 〈 0.01 ）. In comparison with the level before the administration of PS （ 0. 75 ± 0.06）, the level of FiO2 of the 47 pediatric patients receiving mechanical ventilation decreased after the administration of curosurf time-dependently, e. g, was 0.50 ± 0.09, 0.34 ± 0.06, and 0.25 ± 0.07 8, 48, and 96 hours after the administration. In comparison with the level before the administration of curosurf 9.0 ± 1.0 cm H20, the level of mean airway pressure （MAP） decreased time-dependently after the administration, e.g. , were 7.5 ± 0.8 and 6.0 ± 0.3 48 and 96 hours after the administration （ all P 〈 0. 01 ）. Compared with that before the administration of curosurf （ 3.02 ± 0.2 ）, the X-ray chest score decreased time-dependently after the administration of cumsurf, e.g. , were 1.89 ± 0.34, 1.82 ± 0.33, and 1.17 ±0.42 6, 12, and 72 hours after the administration （all P 〈0. 01）. The RDS rate of the PC, group was 30% , siglnificant

关 键 词：新生儿病证 呼吸窘迫综合征 肺表面活性剂 预防性给药 

分 类 号：R722.1[医药卫生—儿科]