牛肺表面活性物质治疗早产儿呼吸窘迫综合征对脑血流动力学的影响  

Effect of bovine pulmonary surfactant on cerebral hemodynamics in premature neonates with respiratory distress syndrome

作　　者：李禄全[1] 余加林[1] 陈静宇[2] 张先红[1] 袁晓丽[1] 

机构地区：[1]重庆医科大学附属儿童医院新生儿诊治中心,重庆400014 [2]重庆医科大学附属儿童医院超声科,重庆400014

出　　处：《第三军医大学学报》2010年第21期2333-2335,共3页Journal of Third Military Medical University

基　　金：<中华儿科杂志>第一届双鹤珂立苏儿科科研基金(2008);重庆市卫生局医学重点学科建设项目[渝卫科教(2010)53号]~~

摘　　要：目的探讨肺表面活性物质珂立苏治疗早产儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)对脑血流动力学的影响。方法 2008年5月至2010年3月,共收治NRDS早产儿301例,观察组(使用珂立苏)162例,对照组(未使用珂立苏)139例。观察组在使用珂立苏前,及使用后0.5、6、12、24、48h采用头颅B超测定脑血流动力学参数,对照组在开始呼吸机辅助呼吸时及0.5、6、12、24、48h进行相同检查。测定的脑血流参数包括:双侧大脑前、中、后动脉及基底动脉收缩期峰值流速(Vs)、舒张末期流速(Vd)及血流阻力指数(RI)。检测完成后按照胎龄相差不超过1周,出生体质量相差不超过500g;初次摄胸片提示的NRDS分级级数相同原则进行逐一配对分析。结果未能完成相关检测指标的观察组33例、对照组41例排除在本研究之外,剩余的观察组129例,对照组98例逐一配对,最终纳入配对数为71对。与对照组相比,观察组除在使用珂立苏后30min时间点大脑前动脉收缩期峰值流速、中动脉血流阻力指数、12h时间点中动脉血流阻力指数低于对照组(P<0.05)外,其余各时间点2组间脑血流参数指标差异无显著性意义(P>0.05)。结论气管内缓慢注入珂立苏治疗早产儿NRDS对脑血流动力学变化无显著影响。Objective To study the effect of bovine pulmonary surfactant（Calsurf）on cerebral hemodynamics in premature neonates with respiratory distress syndrome（RDS）.Methods Three hundred and one neonates with RDS admitted to Children＇s Hospital of Chongqing Medical University in May 2008 to April 2010 were divided into observation group（n=162）and control group（n=139）.Neonates in observation group were treated with Calsurf and those in control group were not given Calsurf.Hemodynamic parameters including systolic peak velocity,diastolic flow velocity and flow resistance index of the anterior,middle and posterior cerebral arteries as well as the basal artery in observation group and control group were detected by cerebral ultrasonography in 0.5,6,12,24 and 48 h after Calsurf administration and before respirator-aided ventilation,respectively.The gestational age less than one week and the birth weight less than 500 g after cerebral ultrasonography were used to match the 2 groups.Severity of RDS suggested on X-ray film was analyzed by paired analysis.Results Thirty-three neonates in observation group and 41 neonates in control group were excluded from this study because no complete data was available.The remaining 129 cases in observation group and 98 cases in control group were finally included.Although the peak systolic flow velocity in anterior cerebral artery in 30 min after Calsurf administration and the resistance index of anterior cerebral artery in 12 h after Calsurf administration were lower in observation group than in control group（P0.05）,and no significant difference was observed in cerebral hemodynamic parameters between the two group at most other time points（P0.05）.Conclusion Slow intravenous injection of Calsurf has no significant effect on cerebral hemodynamics in premature neonates with RDS.

关 键 词：新生儿呼吸窘迫综合征 牛肺表面活性物质 脑血流动力学 早产儿 

分 类 号：R331.37[医药卫生—人体生理学] R722.12[医药卫生—基础医学]