微创肺表面活性物质给药技术治疗新生儿呼吸窘迫综合征的临床疗效及失败的高危因素探讨  

The clinical efficacy of minimally invasive pulmonary surfactant therapy technology in the treatment of neonatal respiratory distress syndrome and the high-risk factors for failure

作　　者：王亚燕[1] 常艳华 Wang Yayan;Chang Yanhua(Department of Pediatric,Affiliated Hospital of Jining Medical College,Jining 272129,China)

机构地区：[1]济宁医学院附属医院儿科,济宁272129

出　　处：《中国医师进修杂志》2022年第8期725-729,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨微创肺表面活性物质(PS)给药技术(MIST)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及失败的高危因素。方法选取2017年7月至2019年7月济宁医学院附属医院诊治的91例NRDS患儿作为研究对象。根据PS给药方式分为MIST组(46例)和气管插管-使用PS-拔管使用持续呼吸道正压通气(INSURE)组(45例),分别通过细血管导管或气管插管给予猪肺磷脂注射液70~100 mg/kg。比较两组临床疗效并分析PS治疗失败的高危因素。结果MIST组总操作时间长于INSURE组[(90.06±14.38)min比(62.57±11.44)min](P<0.05)。两组无创辅助通气时间、总吸氧时间及住院时间比较差异均无统计学意义(P>0.05)。MIST组支气管肺发育不良发生率低于INSURE组[10.87%(5/46)比31.11%(14/45)],差异有统计学意义(χ^(2)=5.64,P<0.05)。男性、剖宫产出生、出生体质量<1500 g、母患妊娠期糖尿病及PS治疗前动脉血氧分压(PaO2)<59 mmHg(1 mmHg=0.133 kPa)、PaO2/吸入氧浓度<185 mmHg、动脉血二氧化碳分压>55 mmHg是MIST失败的高危因素(P<0.05)。结论MIST操作虽有一定难度,但安全可行。临床上应综合分析NRDS患儿存在的各项高危因素,为NRDS患儿选择合适的早期呼吸支持模式。Objective To discuss the clinical efficacy of minimally invasive pulmonary surfactant(PS)therapy technology(MIST)in the treatment of neonatal respiratory distress syndrome(NRDS)and analyze the high-risk factors for failure.Methods A total of 91 NRDS infants treated in the Affiliated Hospital of Jining Medical College from July 2017 to July 2019 were selected as the research objects,and 46 cases were performed minimally MIST(MIST group),45 cases performed intubate-surfactant-extubate to continuous positive airway pressure(INSURE group),the infants were given 70-100 mg/kg porcine pulmonary phospholipid injection through vascular catheter or endotracheal intubation,respectively.The clinical efficacy of the two groups was compared and the risk factors for failure in the treatment of NRDS by PS were analyzed.Results The total operating time in the MIST group was longer than that in the INSURE group:(90.06±14.38)min vs.(62.57±11.44)min,there was statistical difference(P<0.05).The duration of non-invasive auxiliary ventilation,total oxygen uptake time and length of hospitalization time in two groups had no significant differences(P>0.05).The incidence of bronchopulmonary dysplasia in the MIST group was lower than that in the INSURE group:10.87%(5/46)vs.31.11%(14/45),there was statistical difference(χ^(2)=5.64,P<0.05).Univariate analysis showed that the male,cesarean section,birth weight<1500 g,maternal gestational diabetes,arterial partial blood oxygen pressure(PaO2)<59 mmHg(1 mmHg=0.133 kPa)before the application of PS,and PaO2/inhaled oxygen concentration(FiO2)<185 mmHg and arterial partial pressure of carbon dioxide>55 mmHg were high risk factors for failure(P<0.05).Conclusions Although the operation of MIST is difficult,it is safe and feasible.In clinical work,various risk factors should be comprehensively analyzed to select an appropriate early respiratory support model for NRDS children.

关 键 词：肺表面活性物质相关蛋白质类 呼吸窘迫综合征 新生儿 微创伤 物理性 治疗结果 

分 类 号：R722.1[医药卫生—儿科]