肺表面活性物质治疗新生儿呼吸窘迫综合征时有效减少肺出血发生率的应用时限选择的多中心回顾性研究  

Timing for initial therapy of pulmonary surfactant to reduce pulmonary hemorrhage in neonatal respiratory distress syndrome:a multi-center retrospective study

作　　者：李禄全[1] 余加林[1] 封志纯[2] 史源[3] 汪丽[3] 陈盛[4] 钟晓云[5] 陈文[5] 刘建红 刘向红 唐成和[7] 杨卫红[7] 郑军[8] 王晓鹏[8] 刘芳[9] 杜志方[9] 武彦秋[10] 刘霞[10] 周晓玉[11] 胡毓华[12] 张成元[13] 李忠良[13] 杨震英[14] 龙博文 瞿运萍 吕红艳[16] 吴素静[16] 乔彦霞[17] 王素敏[17] 叶青青[18] 卞洪亮[19] 蔡志勇[19] 谢俊英 马友凤 赵柏丽[21] 黄水霞[21] 黎瑞春[22] 

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]北京军区总医院八一儿童医院新生儿科,北京100000 [3]第三军医大学大坪医院野战外科研究所儿科,重庆400042 [4]第三军医大学西南医院儿科,重庆400038 [5]重庆市妇幼保健院新生儿科,重庆400010 [6]山东大学齐鲁儿童医院新生儿科,济南250022 [7]新乡医学院第一附属医院新生儿科,河南新乡463000 [8]天津市中心妇产医院新生儿科,天津300052 [9]白求恩国际和平医院儿科,石家庄130100 [10]承德医学院附属医院儿科,河北承德067000 [11]南京市儿童医院新生儿科,南京210008 [12]江苏省人民医院儿科,南京210029 [13]潍坊市妇幼保健院新生儿科,山东潍坊261011 [14]泰安市妇幼保健院新生儿科,山东泰安271000 [15]萍乡市妇幼保健院儿内科,江西萍乡337055 [16]邯郸市妇幼保健院新生儿科,河北邯郸056001 [17]石家庄市第四医院儿科,石家庄050011 [18]广州市妇婴医院新生儿科,广州510180 [19]盐城市妇幼保健院新生儿科,江苏盐城224002 [20]开封市儿童医院新生儿科,河南开封475000 [21]洛阳市妇女儿童医疗保健中心新生儿科,河南洛阳471000 [22]九江市妇幼保健院新生儿科,江西九江332000

出　　处：《第三军医大学学报》2014年第11期1203-1207,共5页Journal of Third Military Medical University

摘　　要：目的探讨应用肺表面活性物质(pulmonary surfactant,PS)制剂——牛肺表面活性物质(calf pulmonary surfactant,CPS,商品名:珂立苏)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)时有效减少肺出血发生率的最终应用时限。方法收集2008年5月至2009年6月国内22家各级医院新生儿病房应用PS治疗NRDS的相关临床资料。NRDS患儿分为3组,第1组:重度NRDS采用常规机械通气(CMV)+CPS治疗;第2组:轻度NRDS采用CMV+CPS治疗;第3组:轻度NRDS采用鼻塞式持续气道正压通气(nCPAP)+CPS治疗;将生后1、2、3、4、5、6、7、8 h作为时间界点,逐一比较在界点前后使用CPS的各组肺出血的发生率,并探讨NRDS严重程度相同的患儿在不同通气模式下肺出血发生率。结果对于重度NRDS患儿,以生后4、5、6、7、8 h作为使用CPS的时间界点时肺出血的发生率比较差异有统计学意义(P<0.05)。对于轻度NRDS患儿,生后5 h内使用组肺出血发生率明显低于5 h后使用组(3.2%vs9.7%,P<0.05)。对于轻度NRDS患儿,以生后5 h为界点,第3组的肺出血发生率明显低于第2组(0.3%vs 6.5%,P<0.05)。结论生后5 h内使用CPS是治疗NRDS时有效降低肺出血发生率的最后时限,对于轻度NRDS,生后5 h内使用CPS联合nCPAP可明显减少肺出血发生率。Objective Pulmonary hemorrhage （PH） is considered as one of severe adverse events associated with surfactant therapy in the treatment of neonatal respiratory distress syndrome （NRDS）. In this multicenter retrospectively study, we wish to find the timing of initial surfactant administration in order to reduce the incidence of PH. Methods Clinical data of 453 NRDS cases treated by calf pulmonary surfactant （CPS） in the Department of Neonatology out of 22 hospitals during May 2008 to June 2009 were collected and reviewed. These neonates were divided into 3 groups： severe NRDS cases treated by CPS and conventional mechanical ventilation（CMV） （group 1）, mild NRDS cases treated with CPS and CMV （group 2）, and mild RDS cases treated with CPS and nasal continuous positive airway pressure （nCPAP） （group 3）. Postnatal hours 1, 2, 3, 4, 5, 6, 7 and 8 were selected as cutoff times, and the incidence of PH at these time points were analyzed. The incidence of PH between group 2 and 3 were also compared. Results For severe NRDS cases, significant differences in the incidence of PH were found when postnatal hours 4, 5, 6, 7 and 8 were selected as the cutoff time （P〈0.05）. For mild NRDS cases, the incidence of PH was significantly lower in the neonates receiving CPS within 5 h after birth than those beyond 5 h （3.2% vs 9.7%, P〈0.05）. Postnatal hour 5 was selected as the cutoff time for mild NRDS cases, with the incidence of PH obviously lower found in the neonates treated by nCPAP than those by CMV （0.3% vs 6.5%, P〈0.05）. Conclusion Postnatal hour 5 is identified as the timing of initial CPS administration to reduce the incidence of PH. For mild NRDS, the incidence of PH is greatly decreased when initial surfactant administration performed within 5 h after birth followed by nCPAP.

关 键 词：新生儿呼吸窘迫综合征 肺出血 肺表面活性物质 多中心研究 

分 类 号：R725.636[医药卫生—儿科] R725.638[医药卫生—临床医学]