微创肺表面活性物质给药治疗新生儿呼吸窘迫综合征的临床研究  

Clinical effect of minimally invasive surfactant therapy in the treatment of neonatal respiratory distress syndrome

作　　者：赵媛 刘克战 张新华 Zhao Yuan;Liu Kezhan;Zhang Xinhua(Department of Neonatology,the Childrens Hospital of Shanxi(Womens Hospital of Shanxi),Taiyuan,Shanxi 030000,China)

机构地区：[1]山西省儿童医院山西省妇幼保健院新生儿科,太原030000

出　　处：《中国基层医药》2020年第8期940-944,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨微创肺表面活性物质给药(MIST)治疗新生儿呼吸窘迫综合征(RDS)的可行性及安全性。方法选取山西省儿童医院新生儿科2017年4月至2019年4月收治的胎龄32~36周、诊断为RDS需使用外源性肺表面活性物质(PS)治疗的早产儿93例,采用随机数字表法分为MIST治疗组(n=48)和经气管插管给入肺表面活性物质(INSURE)治疗组(n=45),于经鼻持续气道正压通气(NCPAP)基础上分别使用细导管和气管插管给入PS,比较两组疗效及安全性。结果患儿均成功给药,两组给药后心率、呼吸、吸入氧浓度(FiO2)均明显低于给药前,差异均有统计学意义(t=7.739、6.497、7.450,3.992、3.787、4.343,均P<0.05);但两组患儿给药前后心率、呼吸、FiO2差异均无统计学意义(均P>0.05)。两组72 h内机械通气使用率、机械通气时间、NCPAP时间、用氧时间、住院时间及气胸发生率差异均无统计学意义(均P>0.05)。MIST治疗组给药过程中药物反流发生率为20.8%(10/48),明显高于INSURE治疗组的8.3%(4/45)(χ2=3.876,P<0.05);两组心动过缓及经皮血氧饱和度下降发生率、二次给药率差异均无统计学意义(均P>0.05)。结论MIST治疗新生儿RDS有效,但未能提高治疗效果,并有药物反流的不利因素,是否最佳选择需进一步研究。Objective To explore the feasibility and safety of minimally invasive surfactant therapy(MIST)in the treatment of neonatal respiratory distress syndrome(RDS).Methods A total of 93 preterm infants with gestational age of 32-36 weeks admitted from April 2017 to April 2019 were eligible to receive exogenous pulmonary surfactant(PS)with diagnosis as RDS.According to the random digital table method,they were randomly divided into two groups:MIST group(n=48)and intubation-surfactant-extubation(INSURE)treatment group(n=45).During nasal continuous positive airway pressure(NCPAP)ventilation,PS with thin catheter and trachea intubation were chosen,the curative effects of the two groups were compared.Results All infants received PS successfully,the heart rate,breath rate and fraction of inspiratory oxygen(FiO2)after treatment of the two groups were significantly lower than those before treatment,and the differences were statistically significant(t=7.739,6.497,7.450,3.992,3.787,4.343,all P<0.05).However,there were no statistically significant differences in heart rate,breath rate and FiO2 between the two groups whenever before or after administration(all P>0.05).There were also no statistically significant differences in the rate of mechanical ventilation within 72 hours after birth,the time of mechanical ventilation and NCPAP,the time of oxygen inhaling and hospital stays,and the rate of pneumothorax between the two groups(all P>0.05).The incidence of drug reflux in the MIST group[20.8%(10/48)]was higher than that in the INSURE group[8.3%(4/45)](χ2=3.876,P<0.05),but the incidences of bradycardia,transcutaneous oxygen saturation decreased(<85%)and the secondary administration had no statistically significant difference between the two groups(P>0.05).Conclusion MIST is effective in the treatment of RDS in moderately preterm infants,but it presents not too much benefits of effectiveness and complications,as well as the disadvantage of drug reflux,thus whether it is better choice for surfanctant procedure needs more studies.

关 键 词：呼吸窘迫综合征 新生儿 婴儿 早产 肺表面活性物质相关蛋白质类 投药 吸入 心率 呼吸 呼吸 人工 疗效比较研究 

分 类 号：R722[医药卫生—儿科]