LISA技术治疗超低出生体质量儿呼吸窘迫综合征28例  

LISA technique in the treatment of respiratory distress syndrome in 28 cases of infants with ultralow birth mass

作　　者：赵明明 刘玉娟[2] 李忠良[2] 刘小娜 ZHAO Mingming;LIU Yujuan;LI Zhongliang;LIU Xiaona(Department of Pediatrics,Weifang Medical University,Weifang,Shandong 261031,China;Department of Pediatrics,W.F.Maternal and Child Health Hospital,Weifang,Shandong 261021,China)

机构地区：[1]潍坊医学院儿科学教研室,山东潍坊261031 [2]潍坊市妇幼保健院新生儿科,山东潍坊261021

出　　处：《安徽医药》2024年第1期143-147,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)下经微管气管内注入肺表面活性物质(less invasive surfactant administration,LISA)技术在超低出生体质量儿呼吸窘迫综合征(respiratory distress syndrome,RDS)治疗中的应用与疗效。方法采取前瞻性研究方法,选取潍坊市妇幼保健院新生儿科重症监护病房(neonatalintensive careunit,NICU)2019年7月至2021年4月收治的超低出生体质量儿(58例)为研究对象。应用随机数字表法分为LISA组(28例)和气管插管-注入PS-拔管给予经鼻持续气道正压通气(intubation-surfactant-extubation,INSURE)组(30例)。LISA组采用LISA技术,在nCPAP下,气管内置入微管并注入肺表面活性物质(pulmonarysurfactant,PS);INSURE组采用INSURE技术,拔管后给予nCPAP辅助通气。观察并比较两组病儿给药过程、给药前后呼吸机参数、动脉血气、用氧时间及并发症的发生率。结果LISA组病儿72 h内机械通气率低于INSURE组,差异有统计学意义(21.4%比46.7%,P=0.043);LISA组病儿住院期间无创正压通气时间(404.50 h比483.50 h,P=0.033)及总用氧时间(520.00 h比612.50 h,P=0.040)低于INSURE组;LISA组给药1 h后动脉血氧分压(arterial partialpressureof O_(2),PaO_(2))变化高于INSURE组[(54.29±5.69)mmHg比(52.87±3.27)mmHg,P=0.038],差异有统计学意义;LISA组支气管肺发育不良(25.0%比53.3%,P=0.028)及有血流动力学意义的动脉导管未闭发生率(28.6%比56.7%,P=0.031)低于INSURE组,均差异有统计学意义。结论在超低出生体质量儿RDS治疗中,LISA技术在减少72 h内机械通气率、住院期间用氧时间、近期并发症等方面具有优势,是一种安全有效的治疗超低出生体质量儿RDS的方法。Objective To investigate the application and treatment efficacy of the less invasive surfactant administration(LISA)tech⁃nique under nasal continuous positive airway pressure(nCPAP)in the treatment of respiratory distress syndrome(RDS)in infants with ultralow birth mass.Methods A prospective study was conducted.Ultralow birth mass children(58 cases)admitted to the neonatal in⁃tensive care unit(NICU)of W.F.Maternal and Child Health Hospital from July 2019 to April 2021 were selected as the study subjects.The study subjects were divided into the LISA group(28 cases)and the intubation-surfactant-extubation(INSURE)group(30 cases)according to the random number table method.The LISA group used the LISA technique,in which a microtube was placed into the tra⁃chea and injected with pulmonary surfactant(PS)under nCPAP.The INSURE group used the INSURE technique,in which tracheal in⁃tubation-PS.The INSURE group used the INSURE technique,i.e.,tracheal intubation-PS,INSURE,and nCPAP was given to assist ventilation after extubation.The process of drug administration,respiratory parameters,arterial blood gases,oxygen duration and inci⁃dence of complications before and after drug administration were observed and compared between the two groups.Results The rate of mechanical ventilation in the LISA group was lower than that in the INSURE group within 72 h,and the difference was statistically sig⁃nificant(21.4%vs.46.7%,P=0.043).The duration of noninvasive positive pressure ventilation(404.50 h vs.483.50 h,P=0.033)and the total duration of oxygen use(520.00 h vs.612.50 h,P=0.040)were lower than those of the INSURE group.The change in arterial partial pressure of O_(2)(PaO_(2))in the LISA group was higher than that in the INSURE group[(54.29±5.69)mmHg vs.(52.87±3.27)mmHg,P=0.038]after the administration of drugs for 1 h,and the difference was statistically significant.The incidence of dysplasia(25.0%vs.53.3%,P=0.028)and hemodynamically significant arterial duct failure(28.6%vs.56.7%,P=0.031)was lower in the LISA group t

关 键 词：呼吸窘迫综合征 新生儿 肺表面活性物质相关蛋白质类 连续气道正压通气 经微管气管内注入肺表面活性物质(LISA) 婴儿 超低出生体质量 

分 类 号：R722.6[医药卫生—儿科]