不同时间肺泡表面活性物质治疗NRDS临床疗效观察  

Efficacy of alveolar surface active substances in treatment of neonatal respiratory distress syndrome

作　　者：韩晗[1] 李晓霞[1] 帅向华 张志群[1] 李晶[1] 芦惠[1] HAN Han;LI Xiaoxia;SHUAI Xianghua(Department of Pediatrics,Hangzhou First People’s Hospital,Hangzhou 310006,China)

机构地区：[1]杭州市第一人民医院儿科,310006

出　　处：《浙江医学》2020年第12期1278-1281,共4页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF18H160038)。

摘　　要：目的观察不同时间肺泡表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选取杭州市第一人民医院2016年1月至2019年12月确诊为NRDS的204例患儿为研究对象,根据患儿出生后使用PS时间的不同,分为≤3h组103例、>3h组101例;比较两组患儿治疗情况(机械通气时间、氧疗时间及住院时间)、血气指标[氧分压(PaO2)、二氧化碳分压(PaCO2)]及氧合指数(OI)、治疗期间并发症及死亡情况。结果≤3h组患儿氧疗时间、住院时间均明显长于>3h组(均P<0.05)。两组患儿血气指标及OI比较,差异均无统计学意义(均P>0.05);组内各时点比较差异均有统计学意义(均P<0.05),其中PS治疗后12、72h的PaCO2明显下降(均P<0.05),PaO2、OI明显增加(均P<0.05)。两组患儿治疗期间均未发生早产儿视网膜病变,≤3h组支气管肺发育不良发生率明显高于>3h组(均P<0.05),动脉导管未闭(PDA)发生率低于>3h组(均P<0.05);两组患儿颅内出血、肺出血、坏死性小肠结肠炎等并发症发生率及病死率比较,差异均无统计学意义(均P>0.05)。结论早期(生后3h内)使用PS治疗能明显降低NRDS患儿的PDA发生率及高危患儿病死率,虽不能明显缩短高危低体重NRDS患儿的氧疗时间及住院时间,但机械通气时间并不延长。Objective To evaluate the clinical efficacy of pulmonary surfactant(PS)in treatment of neonatal respiratory distress syndrome(NRDS)and its relation with administration timing.Methods A total of 204 children diagnosed with NRDS in Hangzhou First People’s Hospital from January 2016 to December 2019 were enrolled in the study.According to the time of PS treatment after birth,the children were divided into≤3h group(n=103)and>3h group(n=101).The duration of mechanical ventilation and oxygen therapy,length of hospital stay,blood gas index(PaO2,PaCO2),oxygenation index(OI),complications and deaths during treatment were compared between the two groups.Results The duration of oxygen therapy and length of hospital stay in≤3h group were significantly longer than those in>3h group(all P<0.05).There was no significant difference in blood gas index and OI between the two groups(all P>0.05).The differences at each time point within the groups were statistically significant(all P<0.05),in which PaCO2 decreased significantly at 12 and 72 h after PS treatment(all P<0.05),while PaO2 and OI increased significantly(all P<0.05).No retinopathy of prematurity occurred in both groups during the treatment period.The incidence of bronchopulmonary dysplasia in the group≤3h was significantly higher than that in the>3h group(all P<0.05),and the incidence of patency of ductus arteriosus was lower than that in the>3h group(all P<0.05).There was no significant difference between the two groups in the incidence of intracranial hemorrhage,pulmonary hemorrhage,necrotizing enterocolitis and other complications and mortality(all P>0.05).Conclusion Early(within 3h after birth)treatment with PS can significantly reduce the incidence of PDA.Although it cann’t significantly shorten the duration of oxygen therapy and hospital stay in high-risk and low-weight NRDS children,but the mechanical ventilation time doesn’t increase.

关 键 词：肺泡表面活性物质 新生儿呼吸窘迫综合征 血气分析 并发症 

分 类 号：R722.1[医药卫生—儿科]