经胃管微创使用肺泡表面活性物质治疗新生儿呼吸窘迫综合征的疗效分析  

Analysis on curative effects of PS administered by minimally-invasive gastric tube in the treatment of premature infants with NRDS

作　　者：李卫武[1] 何晓红[1] 高丽娟[1] 王传光[1] 蓝菊红[1] 吕卓超[1] 孙增贤[1] 兰俊伟[1] 

机构地区：[1]浙江省丽水市中心医院新生儿科,浙江丽水323000

出　　处：《中国现代医生》2016年第8期49-52,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2016KYA202)

摘　　要：目的探讨采用胃管代替气管导管注射肺泡表面活性物质（pulmonary surfactant,PS）在新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS）患儿治疗中的应用效果。方法选择我院2012年3月～2015年9月在早产儿NRDS的替代中使用肺泡表面活性物质的患儿分为两组,将采用MIST方法的患儿确认为观察组（n=45）;使用INSURE方法为对照组（n=45）。记录两组患儿使用肺泡表面活性物质的量,气管插管次数,插管时间,有创、无创通气时间,吸氧时间。观察治疗中患儿发生气胸,早期败血症等并发症及镇静治疗情况等。结果两组患儿在性别、胎龄、体重、产前激素使用率等方面比较,差异无统计学意义（P〉0.05）。观察组在首次插管1次性成功率,首次气管插管时间,使用肺泡表面活性物质总剂量,再次使用肺泡表面活性物质的插管时间,有创、无创通气时间方面与对照组比较,差异有统计学意义（P〈0.05）。且观察组中有69%的患儿不需要再次进行气管插管,而对照组患儿需要麻醉镇静的患儿增加,提高了气管插管率,延长了通气时间。结论采用MIST方法给药治疗损伤小,不需要镇静,减少给药次数,节约给药量,减少有创与无创通气时间,有效降低治疗期间患儿的并发征。Objective To explore the curative effects of pulmonary surfactant（PS） injected via gastric tube instead of the endotracheal tube in the treatment of infants with neonatal respiratory distress syndrome（NRDS）. Methods Premature infants with NRDS who needed PS replacement therapy were selected from Lishu Center Hospital from March 2012 to September 2015 and divided into two groups： infants with MIST method as the observation group（n=45）, while infants with INSURE method as the control group（n=45）. The two groups of infants were recorded for the amount of PS,the number of tracheal intubation, intubation duration, invasive or noninvasive ventilation duration,and oxygen inhaling duration; and observed for the complications（such as pneumothorax and early sepsis）and effects of sedative treatment,etc. The research data were documented. Results There were no statistically significant differences between two groups of infants in gender, gestational age, body weight and prenatal application rate of hormone（P〉0.05）; while there were statistically significant differences in the one-time success rate of the first intubation, the first trachea intubation duration, total quantity of the PS, the second intubation duration, and the invasive or noninvasive ventilation duration（P〈0.05）. 69% of the infants in the observation group did not need another tracheal intubation, while more infants in the control group needed anesthesia and sedation, thus improving the intubation rate and prolonging the ventilation duration. Conclusion Medication with MIST method has smaller injury to infants and does not need sedation therapy. IT can reduce the medication frequency, dosage and invasive or noninvasive ventilation time, and can effectively reduce the complications during the treatment.

关 键 词：胃管 微创 肺泡表面活性物质 新生儿呼吸窘迫综合征 

分 类 号：R722.1[医药卫生—儿科]