早产儿呼吸窘迫综合征肺表面活性物质治疗两种给药方法比较  

Comparison of the effectiveness of two pulmonary surfactant administration methods among premature infants with respiratory distress syndrome

作　　者：张艳丽 朱鹏[2] 杨蓉 王鑫鑫 尹晓光 ZHANG Yanli;ZHU Peng;YANG Rong;WANG Xinxin;YIN Xiaoguang(Department of Neonatology,Anhui Provincial Maternity and Child Health Hospital,Hefei,Anhui 230001,China;School of Public Health,Anhui Medical University,Hefei,Anhui 230032,China)

机构地区：[1]安徽省妇幼保健院新生儿科,安徽合肥230001 [2]安徽医科大学公共卫生学院,安徽合肥230032

出　　处：《预防医学》2023年第9期757-761,共5页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：国家自然科学基金面上项目(82173531);合肥市卫生健康委员会2021年度应用医学研究项目(HWK2021yb016)。

摘　　要：目的比较微创肺表面活性物质(PS)给药(LISA)和气管插管-PS给药-拔管(INSURE)治疗早产儿呼吸窘迫综合征(RDS)的效果,为提高早产儿RDS治疗效果、减少并发症提供参考。方法选择安徽省妇幼保健院治疗的RDS早产儿71例,随机纳入LISA组和INSURE组,实施基础支持治疗和呼吸支持治疗,分别采用LISA和INSURE给药方法行PS治疗。比较两组患儿的一般资料、治疗前后动脉血气分析、呼吸支持时间和并发症发生率。结果LISA组31例,胎龄为(29.81±0.99)周,男婴22例;INSURE组40例,胎龄为(30.02±1.13)周,男婴26例。两组患儿胎龄、出生体重、性别等一般资料比较,差异均无统计学意义(P>0.05)。治疗后,LISA组PaO_(2)为(78.35±6.55)mmHg,低于INSURE组的(87.68±8.21)mmHg(P<0.05);PaCO_(2)为(43.03±6.34)mmHg,高于INSURE组的(38.68±9.69)mmHg(P<0.05);支气管肺发育不良发生率为48.39%,低于INSURE组的72.50%(P<0.05);线性回归分析结果显示随着LISA给药时间延长(2~7 min),患儿最低心率呈线性增高(β=13,P<0.05)。结论相较于INSURE,LISA给药治疗可缓慢改善RDS早产儿通气氧合,减少过度通气,降低支气管肺发育不良发生率;且适当延长给药时间可降低心率减慢发生率。Objective To compare the effectiveness of less invasive surfactant administration(LISA)and intubate surfac⁃tant extubation(INSURE)on respiratory distress syndrome(RDS)among premature infant,so as to provide insights into improving treatment effects and reducing complications of RDS among premature infants.Methods A total of 71 prema⁃ture infants with RDS in Anhui Provincial Maternity and Child Health Hospital were randomly assigned into the LISA and INSURE group,and pulmonary surfactant(PS)administration was carried out by LISA and INSURE with basic sup⁃port therapy and respiratory support therapy.The general information,arterial blood gas analysis before and after treat⁃ment,respiratory support time and incidence of complications were collected and compared between the two groups.Re⁃sults There were 31 cases in the LISA group,with a gestational age of(29.81±0.99)weeks and 22 male cases,and 40 cases in the INSURE group,with a gestational age of(30.02±1.13)weeks and 26 male cases.There were no signifi⁃cant differences in basic characteristics(including gestational age,birth weight,gender,etc.)between the two groups(all P>0.05).After administration,the level of PaO2 was lower in the LISA group than in the INSURE group[(78.35±6.55)mmHg vs.(87.68±8.21)mmHg,P<0.05],the level of PaCO2 was higher in the LISA group than in the INSURE group[(43.03±6.34)mmHg vs.(38.68±9.69)mmHg,P<0.05],and the incidence of bronchopulmonary dysplasia was lower in the LISA group than in the INSURE group(48.39%vs.72.50%,P<0.05).Linear regression analysis showed that with the duration of LISA administration increase(2-7 min),the minimum heart rate of premature infants increased linearly(β=13,P<0.05).Conclusions Compared with INSURE,LISA administration could slowly improve ventilation oxygen⁃ation,reduce hyperventilation and incidence of bronchopulmonary dysplasia among premature infants with RDS.The inci⁃dence of slow heart rate may be reduced by appropriately prolonging the administration duration.

关 键 词：早产儿 呼吸窘迫综合征 微创肺表面活性物质给药 气管插管-肺表面活性物质给药-拔管 

分 类 号：R722.6[医药卫生—儿科]