布地奈德联合肺表面活性物质对机械通气极低出生体质量儿脑损伤的保护作用  

Protective effect of Budesonide mixed with pulmonary surfactant on brain damage of very low birth weight premature treated with mechanical ventilation

作　　者：晏路标[1] 韩树萍[1] 储晓彬[2] 郭锡熔[1] 余章斌[1] 

机构地区：[1]南京医科大学附属南京妇幼保健院新生儿科,210004 [2]南通市第一人民医院儿科

出　　处：《中华实用儿科临床杂志》2014年第6期419-423,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：第二届双鹤珂立苏科研基金（cjp2011008）;南京医科大学科技发展基金（2010NJMU025）;南通市科技发展基金（S2010060）

摘　　要：目的探讨对机械通气极低出生体质量儿使用肺表面活性物质（Ps）联合布地奈德（BUD）后对脑血流的影响，寻求对脑损伤的保护机制。方法2010年8月至2012年3月南京妇幼保健院收治的胎龄〈34周，出生体质量〈1500g，出生1h内发生呼吸窘迫综合征（RDS）需要机械通气的早产儿40例，随机分为研究组和对照组。研究组使用Ps和BUD混合剂（每70mgPS中加入0．25mgBUD），剂量Ps70mg／kg，BUD0．25mg／kg。对照组单独使用PS，剂量70mg／kg。在出生30～60min由气管内滴入。通过多普勒超声监测2组患儿大脑中动脉血流速度指标和血管弹性指标[包括收缩期峰值流速（Vs）、舒张末期血流速度（Vd）、平均血流速度（Vm）、血流阻力指数（RI）、搏动指数（PI）]，随访2组患儿脑室周围-脑室内出血（PVH—IVH）和脑室周围白质软化（PVL）的发生率。结果研究组Vs稳定上升，对照组不稳定，第4、5、6、7天2组间比较差异均有统计学意义（t=3．21、2．95、3．12、3．43，P均〈0．05）；研究组Vd稳定上升，对照组不稳定，第4、5、6、7天2组问比较差异均有统计学意义（t=4．21、3．10、3．98、4．56，P均〈0．05）；研究组Vm高于对照组，第4、5、6、7天2组问比较差异均有统计学意义（t=2．68、2．98、3．98、3．57，P均〈0．05）；研究组RI值高于对照组，第5、6、7天2组间比较差异均有统计学意义（t=3．10、3．98、4．06，P均〈0．05）；PI值研究组平稳，对照组不稳定，第5、6、7天2组间比较差异均有统计学意义（t=4．18、3．23、3．02，P均〈0．05）。研究组重度PVH—IVH发生率比对照组减少（r=4．80，P〈0．05）；PVL发生率研究组比对照组减少，差异有统计学意义（χ2=3．31，P〈0．05）。结论使用BUD联合Ps可以稳定机械通气极低出生体质量儿脑血流变化，减少脑损伤发生。Objective To explore the influence of middle cerebral artery blood flow on mechanical ventilation in very low birth weight premature after using Budesonide （BUD） mixed with pulmonary surfactant （PS） , and to explore the protection mechanism of cerebral injury. Methods Forty premature infants （ gestational age 〈 34 weeks, birth weight 〈 1 500 g） with respiratory distress syndrome（RDS） were randomly assigned into study group and control group in Nanjing Maternal and Child Health Hospital from Aug. 2010 to Mar. 2012. PS and BUD mixture was used in study group （Per 70 mg PS adding BUD 0.25 rag） ,PS dose of 70 mg/kg,BUD dose of 0.25 mg/kg. Control group was only administered with PS, dose 70 mg/kg. It was administered intratracheally after 30 to 60 minutes of birth in both groups. The index of blood flow rate and blood vessel elasticity of arteria cerebri media [ including systolic velocity （Vs） , dias- tolic velocity（Vd）, mean velocity（Vm）, resistant index（RI） and elasticity index （PI）~ were monitored by using tran- scranial Doppler. Results The Vs increased steadily in study group, but instability in control group, and there were of statistical differences on the 4 d,5 d,6 d and 7 d （ t = 3.21,2.95,3.12,3.43, all P 〈 0. 05 ）. The Vd increased steadily in study group,but unsteadily in control group,and there were statistical differences on the 4 d,5 d,6 d and 7 d （t = 4.21,3.10,3.98,4.56 ,all P 〈0.05 ）. The Vm of study group was higher than that in the PS group ,and there were sta- tistical differences on the 4 d,5 d,6 d and 7 d （ t = 2.68,2.98,3.98,3.57, all P 〈 0.05 ）. The RI of study group was higher than that in the control group, and there were statistical differences in the 5 d,6 d and 7 d（t = 3.10,3.98,4.06, all P 〈 0.05 ）. PI steadily in study group, but instability in control group, and there were statistical differences in the 5 d,6 d and 7 d （ t =4.18,3.23,3.02 ,all P 〈0.05 ）. The overall incidence of periventricular/intraventricular

关 键 词：肺表面活性物质 布地奈德 大脑中动脉血流 脑损伤 

分 类 号：R651.15[医药卫生—外科学]