肺表面活性物质对不同胎龄早产儿肺透明膜病的预防作用  

The prophylaxis of pulmonary surfactant on hyaline membrane disease in preterm infants with different gestational ages

作　　者：韩庆华[1] 聂川[4] 王斌[3] 罗先琼[4] 吴瑕[2] 何伟仪[2] 陈文超[2] 柳国胜[2] 

机构地区：[1]深圳市妇幼保健院新生儿科,518028 [2]暨南大学附属第一医院儿科,广州510632 [3]南方医科大学附属珠江医院儿科,广州510282 [4]广东省妇幼保健院新生儿科,广州510010

出　　处：《中国小儿急救医学》2010年第2期123-126,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的分析不同胎龄早产儿应用肺表面活性物质（PS）预防新生儿肺透明膜病（HMD）的临床疗效及安全性，探讨应用PS预防HMD的最佳时机。方法2000年9月至2006年9月3所医院NICU收治胎龄〈35周的早产儿911例，其中预防性应用PS146例（预防组），未预防性应用PS765例（非预防组）。比较两组间不同胎龄早产儿的HMD患病率、7d内病死率、机械通气时间、总吸氧时间、住院时间及主要并发症的发生情况。结果预防组HMD患病率较非预防组降低了28．1％（P〈0．05）。预防组中胎龄〈30周、30周和31周早产儿HMD患病率较非预防组分别降低了43．2％、58．4％、50．9％（P〈0．05）。预防组7d内病死率（6．2％）较非预防组（18．2％）明显降低（P〈0．05）；其胎龄〈30周、30周和31周早产儿7d内病死率分别减低了23．0％、26．0％、17．6％（P〈0．05）。预防组机械通气时间、总吸氧时间均较非预防组明显降低（P〈0．05）；但住院时间差异无显著性（P〉0．05）。预防组肺出血、呼吸机相关性肺炎、气漏的发生率均低于非预防组（P〈0．05）。结论预防性应用PS可减少HMD患病率，降低早产儿的病死率，缩短机械通气和总吸氧时间，减少肺出血、呼吸机相关性肺炎、气漏的发生率。胎龄≤31周的早产儿预防性应用Ps效果更为显著。Objective To evaluate the clinical effects and safety of pulmonary suffactant（PS）on hyaline membrane disease（HMD） in preterm infants of different gestational ages,and to discuss the best opportunity for prophylaxis on HMD with PS. Methods Nine hundred and eleven preterm infants with gestafional a- ges （GA） 〈35 weeks were analyzed retrospectively,among which 146 babies given PS prophylactically were classified as Group A, and the other 765 babies without PS as Group B. HMD morbidity and mortality within 7 days,as well as the period of mechanical ventilation,oxygen therapy and hospitalization and major complications were analyzed statistically in both groups. Results Compared to Group B,HMD morbidity within 7 days was significantly lower by 28. 1% （ P 〈0. 05 ） in Group A. HMD morbidities within 7 days in babies with GA 〈 30 weeks,GA =30 weeks and 31 weeks of Group A were reduced by 43. 2% ,58. 4% and 50. 9% respectively. A significant difference in the 7-days mortality was observed between Group A （6. 2% ） and Group B （ 18. 2% ）. The mortality of babies with GA 〈30 weeks,GA =30 weeks,GA =31 weeks in Group A reduced by 23. 0% ,26. 0% and 17. 6% respectively with prophylactic administration of IS. There were significant differ ences in the time of ventilation and oxygen therapy （ P 〈 0. 05 ）, but no difference was showed in the time of hospitalization between two groups（ P〉0. 05）. Compared to Group B,Group A had a lower incidence of lung hemorrhage, ventilator-associated pneumonia and air leak （P 〈 0. 05）. Contusion Prophylactic administration of PS results in lower HMD morbidity and mortality ,shortening the time of ventilation and oxygen therapy ,as well as reducing complication incidence such as lung hemorrhage, ventilator-associated pneumonia, air leak ,particularly in the preterm infants with GA≤31 weeks.

关 键 词：婴儿 新生 早产 新生儿肺透明膜病 肺表面活性物质 胎龄 

分 类 号：R722.1[医药卫生—儿科]