雾化吸入布地奈德对支气管肺发育不良高危早产儿呼吸支持时间影响的随机对照研究  

The effects of inhaled budesonide on the duration of respiratory support in preterm infants with high-risk of bronchopulmonary dysplasia:a randomized controlled trial

作　　者：施鸿珊 赵丹丹 张崇巽 徐思媛 王冰洁 孙中怡 李敏[1] 杨波 高翔羽[1] Shi Hongshan;Zhao Dandan;Zhang Chongxun;Xu Siyuan;Wang Bingjie;Sun Zhongyi;Li Min;Yang Bo;Gao Xiangyu(Department of Neonatology,Xuzhou Central Hospital(Xuzhou Clinical College of Xuzhou Medical University),Xuzhou 221009,China)

机构地区：[1]徐州市中心医院(徐州医科大学徐州临床学院)新生儿科,徐州221009

出　　处：《中华新生儿科杂志（中英文）》2024年第12期705-710,共6页Chinese Journal of Neonatology

基　　金：江苏省妇幼保健协会科研项目(FYX202331);徐州市科技局重点研发计划(KC22170)。

摘　　要：目的探讨生后7~14 d开始雾化吸入布地奈德对支气管肺发育不良(bronchopulmonary dysplasia,BPD)高危早产儿呼吸支持时间的影响。方法选择2021年3月至2023年12月徐州市中心医院收治的日龄7~14 d仍需要无创呼吸支持的BPD高危早产儿,随机分为两组,布地奈德组给予雾化吸入布地奈德(0.5 mg,每12 h一次)至停止呼吸支持;对照组仅给予雾化吸入生理盐水,比较两组呼吸支持时间和相关的有效性及安全性指标。结果共纳入87例,布地奈德组44例,对照组43例。布地奈德组总呼吸支持时间[(36.6±15.4)d比(43.0±13.4)d,P=0.043]和常压吸氧时间[(20.1±8.7)d比(24.2±8.3)d,P=0.028]短于对照组(P<0.05);两组正压/高流量呼吸支持时间、总BPD发生率、轻度及中重度BPD发生率、短疗程低剂量地塞米松方案使用率、高血糖、消化道出血、晚发败血症、肺出血、气漏综合征、Ⅱ~Ⅲ期坏死性小肠结肠炎、Ⅱ~Ⅳ度脑室内出血、初次筛查需治疗的早产儿视网膜病、有血流动力学意义的动脉导管未闭发生率、红细胞悬液输注量及住院天数等差异均无统计学意义(P>0.05)。结论生后7~14 d开始雾化吸入布地奈德,能缩短BPD高危早产儿的呼吸支持时间,未增加不良反应和不良结局发生率,但未能降低BPD发生率和减轻BPD严重程度。ObjectiveTo study the effects of inhaled budesonide during 7-14 d after birth on the duration of respiratory support in preterm infants with high-risk of bronchopulmonary dysplasia(BPD).MethodsFrom March 2021 to December 2023,preterm infants admitted to our hospital and still needed non-invasive respiratory support at 7-14 d of age were randomly assigned into two groups.The budesonide group inhaled budesonide(0.5 mg,once every 12 h)until withdrawal of respiratory support and the control group inhaled saline alone.The duration of respiratory support,effectiveness and safety indicators were compared between the two groups.ResultsA total of 87 cases were enrolled,including 44 in the budesonide group and 43 in the control group.The total duration of respiratory support[(36.6±15.4)d vs.(43.0±13.4)d,P=0.043]and the duration of atmospheric oxygen inhalation[(20.1±8.7)d vs.(24.2±8.3)d,P=0.028]in the budesonide group were shorter than the control group(P<0.05).No significant differences existed between the two groups in the following items:duration of positive pressure or high flow respiratory support,the overall incidence and different grades of BPD,usage of short-course low-dose dexamethasone therapy,hyperglycemia,gastrointestinal bleeding,late-onset sepsis,pulmonary hemorrhage,air leak syndrome,stageⅡ-Ⅲnecrotizing enterocolitis,stageⅡ-Ⅳintraventricular hemorrhage,retinopathy of prematurity requiring treatment at initial screening,the volume of erythrocyte suspension infusion,haemodynamically significant patent ductus arteriosus at discharge and the length of hospital stay(all P>0.05).ConclusionsInhaled budesonide during 7-14 d of life may shorten the duration of respiratory support in preterm infants with high-risk for BPD,without increasing the incidences of adverse effects and poor outcomes.However,budesonide does not effectively reduce the overall incidence and the severity of BPD.

关 键 词：布地奈德 雾化吸入 呼吸支持 支气管肺发育不良 早产儿 

分 类 号：R722.6[医药卫生—儿科]