不同方法治疗早产儿呼吸窘迫综合征的安全性和有效性比较  

Comparison of the safety and efficacy of different methods for the treatment of respiratory distress syndrome in preterm infants

作　　者：陆国琴 黄华飞[1] 张慧杰 李小青 李贝贝 LU Guo-qin;HUANG Hua-fei;ZHANG Hui-jie;LI Xiao-qing;LI Bei-bei(Department of Neonatology,Jiaxing Maternal and Child Health Hospital,Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市妇幼保健院新生儿科,浙江嘉兴314000

出　　处：《中国妇幼保健》2023年第13期2370-2374,共5页Maternal and Child Health Care of China

基　　金：浙江省嘉兴市科技计划项目(2020AD30040)。

摘　　要：目的比较传统的气管插管-使用肺表面活性物质-拔管(INSURE)技术和低侵入性肺表面活性物质灌注(LISA)技术治疗早产儿呼吸窘迫综合征(RDS)的安全性和有效性。方法选取2018年6月—2020年10月嘉兴市妇幼保健院新生儿重症监护病房(NICU)收治的在该院出生的双胎RDS早产儿(胎龄<32周,体质量<1500 g)40例为研究对象。运用前瞻性研究方法,将入组患儿采用随机数字表法分别纳入LISA组(20例)和INSURE组(20例)。比较两组患儿基本情况;观察两组患儿插管时间、置管成功率、PS反流率;操作过程中呼吸、心率、血氧饱和度变化及脑电图监测;治疗前0.5 h和治疗后8 h动脉血气分析指标改善情况;再次给药和72 h内需机械通气的比例。结果LISA组患儿首次插管成功率为85.00%,INSURE组一次性插管成功,但两组比较差异无统计学意义(χ^(2)=0.256,P>0.05)。两组患儿插管时间、经皮氧饱和下降范围、心动过缓发生率、呼吸暂停发生率、再次使用PS比例及出生后72 h内机械通气比例比较,差异均无统计学意义(均P>0.05)。给药过程中比较,LISA组药物反流发生率(30.00%)高于INSURE组(5.00%),差异有统计学意义(χ^(2)=4.329,P<0.05)。治疗后8 h,LISA组动脉血氧分压(PaO_(2))、动脉血氧分压/吸入氧浓度(PaO_(2)/FiO_(2))均显著高于INSURE组,动脉血二氧化碳分压(PaCO_(2))、吸入氧浓度(FiO_(2))均显著低于INSURE组,差异均有统计学意义(均P<0.05)。置管时两组患儿最低电压和爆发间期比较,差异均无统计学意义(均P>0.05)。注入PS时、拔管即刻、拔管15 min、拔管30 min,LISA组患儿最低电压均高于INSURE组,而爆发间期短于INSURE组,差异均有统计学意义(均P<0.05)。LISA组抑制性脑电恢复至正常时间优于INSURE组,差异有统计学意义(P<0.05)。结论LISA技术治疗早产儿RDS安全有效,与INSURE技术相比,LISA治疗可改善血气分析指标,促使肺功能有效恢复,同时对脑电�Objective To comparethe safety and efficacyof the conventional intubation-surfactant-extubation(INSURE)technique with the less invasive surfactant administration(LISA)technique for the treatment of respiratory distress syndrome(RDS)in preterm infants.Methods A total of 40 cases of twin premature infants with RDS(gestational age less than 32 weeks and weight less than 1500g)admitted to NICU of Jiaxing Maternal and Child Health Hospital from June 2018 to October 2020 were selected as research objects.Using prospective research methods,the enrolled premature infants were divided into the LISA group(20 cases)and the INSURE group(20 cases)according to a random number table.The basic conditions of the two groups were compared.The differences of intubation time,one-time success rate of intubation,PS reflux rate,changes of breathing,heart rate,blood oxygen saturation and electroencephalography(EEG)signals during treatment,improvement of arterial blood gas analysis 0.5 hours before and 8 hours after treatment,medication reuse rate,72 hours mechanical ventilation rate between the two groups were analyzed.Results The one-time success rate of the LISA group was 85.00%,while that in the INSURE group was 100.00%,but there was no significant difference(χ^(2)=0.256,P>0.05).There were no significantly differences between the LISA group and the INSURE group among intubation time,transcutaneous oxygen saturation drop range,incidence of bradycardia and apnea,PS reuse rate,and 72 hours mechanical ventilation rate(P>0.05).During the administration,the medication reflux rate was higher in the LISA group(30.00%)than that in the INSURE group(5.00%),with significantly differences(χ^(2)=4.329,P<0.05).After treatment 8 hour,the partial pressure of arterial oxygen,and the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen(PaO_(2)/FiO_(2))of the LISA group were significantly higher than those of the INSURE group,while the partial pressure of arterial carbon dioxide(PaCO_(2))and the fractional inspired oxygen

关 键 词：早产儿 呼吸窘迫综合征 低侵入性肺表面活性物质灌注技术 持续气道正压通气 振幅整合脑电图 

分 类 号：R725.6[医药卫生—儿科]