肺表面活性物质替代治疗与支气管肺发育不良的关系  

Effect of pulmonary surfactant on the incidence of bronchopulmonary dysplasia

作　　者：叶秀桢[1] 杨杰[1] 吴婕翎[1] 邓群娣[1] 聂川[1] 李文成[1] 王越[1] 

机构地区：[1]广东省新生儿ICU医疗质量控制中心广东省妇幼保健院新生儿科,广州510010

出　　处：《中华急诊医学杂志》2009年第6期584-587,共4页Chinese Journal of Emergency Medicine

基　　金：广东省科技计划项目立项资助（2007B031500009）

摘　　要：目的探讨不同剂量啼表面活性物质（PS）替代治疗早产儿肺透明膜病（HMD）与发生支气管肺发育不良（BPD）的关系。方法将2005年1月至2007年12月入住本院新生儿科并出现生后进行性呼吸困难且胸片提示考虑诊断为HMD的403例早产儿，依据家属经济条件使用首剂IX5情况分三组进行前瞻性的临床对照研究：低剂量PS组（L-PS组，剂量≤100mg／kg，n=188）、高剂量PS组（H—PS组，剂量〉100mg／kg，n=94）和未使用PS组（N—PS组，n=121）；采用自身对照和组间比较观察PS治疗6h后患儿吸氧浓度（FiO2）、肺部氧合功能，以及三组间观察总氧疗时间、机械通气时间、再次插管机械通气率、住院时间和BPD发生情况。结果与N—PS组患儿比较，在给予Ps治疗6h后，LPS组和H-PS组两组患儿的FiO2，OI明显降低，PO2和a／APO2比值均明显升高（P〈0．05）；氧疗时间和机械通气时间均明显缩短，较少发生再次插管机械通气（P〈0．05）；且以H—PS组患儿改变显著，差异均具有统计学意义（P〈0．05）。H—PS组患儿BPD发生（11例，11．7％）明显低于N—PS组（29例，24．0％），差异具有统计学意义（F1-3=4．267，P=0．006）；L-PS组BPD发生（34例，18．1％）虽然低于N—PS组，但差异无统计学意义（F1-2=1．354，P=0．062）。结论PS替代治疗能有效地改善肺部氧合功能，减少机械通气时间和再次捅管机械通气发生率，且以大剂量（〉100mg／kg）的效果更明显，并能有效地预防BPD的发生。Objective To explore the effect of different dosage of pulmonary surfaetant （PS） on the ineidonee of bmnchopulmonary dysplasia. Method Four hundred and three premature infants with hyaline membrane disease were divided into 3 groups according to the dose of PS： low-dose group （DPS group, ≤ 100 mg/kg, n = 188） ,high-dose group（H-PS group, 〉 100 mg/kg, n = 94） and no-PS group （N-PS group, n = 121 ）. The fractional inspired oxygen（FiO2） and pulmonaryT oxygenating function hefore and ＂,filer 6 hours treatment were observed and the durations of oxygen therapy and mechanical ventilation, frequency of repeated intubation, length of hospitalization and the incidence of BPD were compared among the three groups. Results After 6 hours PS administration, the FiO2, oxygen index and duration of oxygen therapy and mechanical ventilation were significantly decreased （P 〈 0.05）, while PO2 and the artefio-alveolar partial pressure of oxygen were significantly increased （P 〈 0.05）in the H-PS and L-PS groups, compared with the N-PS group. Compared with the L-PS and N-PS groups, the H-PS group showed a decreased incidence of BPD. Conclusions PS administration could improve the pulmonary oxygenation and prevent the development of BPD, especially in high-dose.

关 键 词：肺表面活性物质 肺透明膜病 支气管怖发育不良 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科] R722.12[医药卫生—临床医学]