肺表面活性物质对选择性剖宫产患儿预防新生儿呼吸窘迫综合征的临床研究  

The effect of pulmonary surfactant on prevention of neonatal respiratory distress syndrome in neonates delivered via caesarean section

作　　者：杨丽娟[1] 袁玉芳[1] 赵赛[1] 程怀平[1] 田兆方[1] Yang Lijuan Yuan Yufang Zhao Sai Cheng Huaiping Tian Zhaofang(Huai＇ an First Hospital Affiliated to Nanfing Medical University, Jiangsu Huai＇ an 223300, Chin)

机构地区：[1]南京医科大学附属淮安第一医院新生儿科,江苏淮安223300

出　　处：《中国医师进修杂志》2016年第11期1005-1008,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的：研究肺表面活性物质（PS）对选择性剖宫产患儿新生儿呼吸窘迫综合征（NRDS）的预防作用。方法从胎龄34～38＋6周选择性剖宫产患儿中选择试管振荡试验阴性且羊水肺表面活性物质相关蛋白A（SP-A）浓度较低（＜10μg/L）的患儿80例，按随机数字表法分为PS预防组和对照组，每组40例，PS预防组患儿生后1 h经气管插管给予猪肺磷脂注射液（用量100 mg/kg），对照组不予特殊处理。对比两组NRDS发生率、治疗情况和临床进展情况。结果对照组NRDS发生率为82.5%（33/40），显著高于PS预防组的37.5%（15/40），差异有统计学意义（P＜0.05），且对照组呼吸窘迫程度重。对照组新生儿持续性肺动脉高压、肺气漏、动脉导管未闭发生率和氧合指数＞25 mmHg（1 mmHg＝0.133 kPa）比例均高于PS预防组，差异有统计学意义（P＜0.05）。对照组机械通气时间、用氧时间、上机前动脉血氧分压（PaO2）与吸入氧浓度（FiO2）比值和住院费用均高于PS预防组，差异均有统计学意义（P＜0.05）。结论 PS可以减少选择性剖宫产患儿发生NRDS,并可以减轻NRDS症状，缩短住院时间，减少住院费用。Objective To study the pulmonary surfactant （PS） on prevention of neonatal respiratory distress syndrome （NRDS） in neonates delivered via caesarean section. Methods From selective cesarean section infants （gestational age 34-38＋6 W）, 80 cases whose test tube oscillation tests were negative and amniotic fluid pulmonary surfactant associated protein A （SP-A） concentrations were lower than 〈10μg/L, and were randomly divided into PS prevention group and control group, with 40 cases in each group. PS prevention group within 1 h of birth were administrated poractant alfa injection by endotracheal tube （dose 100 mg/kg）, but the control group was not given special treatment, leaving only the observation. The incidence of NRDS, treatment status and clinical progression were compared between two groups. Results The incidence of NRDS in control group was 82.5%（33/40）, in PS prevention group was 37.5%（15/40）, and there was significant difference （P〈0.05）. The degree of NRDS in control group was more severe. The incidence rate of persistent pulmonary hypertension of the new-born （PPHN）, pulmonary air leak, patent ductus arteriosus and oxygenation index above 25 mmHg （1 mmHg=0.133 kPa） in control group were significantly higher than those in PS prevention group （P〈0.05）. The time of mechanical ventilation, the time of oxygen inhalation, ratio of arterial partial pressure of oxygen （PaO2） before mechanical ventilation to fraction of inspired oxygen （FiO2）, and costs of hospitalization in control group were significantly higher than those in PS prevention group （P〈0.05）. Conclusions PS prevention can reduce the incidence of NRDS of neonates delivered by elective caesarean section, can alleviate the symptoms of NRDS, shorten length of stay and reduce the cost of hospitalization.

关 键 词：剖宫产术 呼吸窘迫综合征 新生儿 肺表面活性物质 

分 类 号：R720.597[医药卫生—急诊医学]