布地奈德干预治疗重度新生儿急性呼吸窘迫综合征的临床分析  

Clinical analysis of budesonide intervention in the treatment of severe neonatal acute respiratory distress syndrome

作　　者：尹晓娟 张宣 陈佳[2] 池婧涵 韩涛[2] 赵丹华 贺艳梅 封志纯 YIN Xiao-juan;ZHANG Xuan;CHEN Jia;CHI Jing-han;HAN Tao;ZHAO Dan-hua;HE Yanmei;FENG Zhi-chun(Pediatrics,Hainan Hospital of PLA Genenal Hospital,Hainan 100191,China;Neonatal Intensive Care Unit of Bayi Children's Hospital,Seventh Medical Center of PLA General Hospital,Beijing 100700,China)

机构地区：[1]解放军总医院海南分院儿科,海南100191 [2]解放军总医院第七医学中心八一儿童医院新生儿重症监护病房,北京100700

出　　处：《发育医学电子杂志》2020年第1期47-52,共6页Journal of Developmental Medicine (Electronic Version)

基　　金：国家自然科学基金(30871397)

摘　　要：目的探讨布地奈德对重度新生儿急性呼吸窘迫综合征(neonatal acute respiratory distress syndrome,NARDS)的治疗效应。方法选择2017年12月31日至2019年11月30日在解放军总医院第七医学中心八一儿童医院NICU住院的70例重度NARDS为研究对象,随机分为干预组和对照组,每组35例。干预组经气管插管导管内滴入布地奈德,每次0.5 mg/kg,每8小时一次,连用2 d;对照组以同样方式给予相同体积的生理盐水。收集两组患儿的围产期孕母资料、新生儿资料和血气分析指标等。采用两独立样本t检验、χ^2检验或Fisher精确概率法进行统计学分析。结果两组围产期孕母资料比较,差异无统计学意义(P>0.05)。干预组HFOV使用的比例(74.3%)高于对照组(51.4%)(χ^2=3.916,P<0.05)。干预组使用肺表面活性物质的比例(45.7%)低于对照组(71.4%)(χ^2=4.769,P<0.05));干预组气漏发生的比例(2.9%)低于对照组(20.0%)(P<0.05);干预组气道高反应性(咳嗽)发生的比例(14.3%)低于对照组(48.6%)(χ^2=9.545,P<0.05)。两组间的住院时间、死亡和体外膜肺氧合(ECMO)治疗的比例差异无统计学意义(P值均>0.05);两组间高血压、水肿、低钾血症、高钠血症发生的比例比较差异无统计学意义(P值均>0.05)。干预组与对照组比较,治疗前和治疗后7 d两组的二氧化碳分压(PaCO2)、氧分压(PaO2)和氧合指数(OI),3项指标差异均无统计学意义(P值均>0.05)。结论布地奈德能减少气漏、阻止或减轻气道高反应性的发生,对NARDS具有治疗效应。Objective To investigate the therapeutic effect of budesonide on severe neonatal acute respiratory distress syndrome(NARDS).Methods In the neonatal intensive care unit(NICU)of Bayi Children's Hospital,Seventh Medical Center of PLA General Hospital,70 cases with severe NARDS were recruited from December 31,2017 to November 30,2019 and randomly divided into two groups,35 cases in the intervention group and 35 cases in the control group.In the intervention group,budesonide was used with intratracheal instillation,0.5 mg/kg per time,once per 8 hours,for 2 days;the control group was given the same volume of saline in the same way.Perinatal pregnancy maternal,neonatal clinical data and blood gas analysis indicators of the two groups were collected and analyzed.The statistical analysis was carried out by t test,χ^2 test or Fisher's exact test.Results There was no significant difference in perinatal maternal data between the two groups(P>0.05).The ratio of HFOV used in the intervention group(74.3%)was higher than that in the control group(51.4%)(χ^2=3.916,P<0.05),while the ratio of pulmonary surfactant used in the intervention group(45.7%)was lower than that in the control group(71.4%)(χ^2=4.769,P<0.05).The ratio of air leakage in the intervention group(2.9%)was lower than that in the control group(20.0%)(P<0.05).The ratio of airway hyperresponsiveness(cough)in the intervention group(14.3%)was lower than that in the control group(48.6%)(χ^2=9.545,P<0.05).There was no statistical significance in the length of hospitalization,death,and ECMO treatment between the two groups(all P>0.05);there was no statistical significance in the ratio of hypertension,edema,hypokalemia,and hypernatremia between the two groups(all P>0.05).There was also no statistical significance in PaCO2,PaO2 and OI before and 7 days after treatment between the two groups(P>0.05).Conclusion Budesonide can reduce air leakage,prevent or alleviate airway hyperresponsiveness,and has therapeutic effect on NARDS.

关 键 词：新生儿 急性呼吸窘迫综合征 布地奈德 气漏 肺表面活性物质 

分 类 号：R722.1[医药卫生—儿科]