微创给药对极早产儿呼吸窘迫综合征的疗效观察  

Observation of the therapeutic effect of less invasive surfactant administration on respiratory distress syndrome in extremely premature infants

作　　者：何源[1] 杨树杰[1] 曾英 易海英 黄杰[1] 甘斌[1] 魏贤[1] 唐艳林[2] HE Yuan;YANG Shujie;ZENG Ying;YI Haiying;HUANG Jie;GAN Bin;WEI Xian;TANG Yanlin(Department of Neonatology,Xiaogan Central Hospital,Xiaogan 432100,Hubei,China;Department of Medical Laboratory,Xiaogan Central Hospital,Xiaogan 432100,Hubei,China)

机构地区：[1]孝感市中心医院(武汉科技大学附属孝感医院)新生儿科,湖北孝感432100 [2]孝感市中心医院(武汉科技大学附属孝感医院)检验科,湖北孝感432100

出　　处：《中国现代医生》2024年第35期59-63,共5页China Modern Doctor

基　　金：湖北省孝感市自然科学计划项目(XGKJ2021010080)。

摘　　要：目的观察微创法(less invasive surfactant administration,LISA)给药对极早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效及安全性。方法选取2021年1月至2023年12月孝感市中心医院新生儿科收治的胎龄28+0~31+6周被诊断为呼吸窘迫综合征的极早产儿65例作为研究对象,采用随机数字表法分为LISA组(n=33)和气管插管-注入肺表面活性物质-拔管(intubation,administration of surfactant,extubation,InSurE)组(n=32),比较两组给药过程中不良事件发生率、给药前后血气分析、经皮血氧饱和度(pulse oxygen saturation,SpO2)、血压的变化情况及临床疗效、并发症和转归。结果操作过程中,两组患者的药物反流、心动过缓、呼吸暂停或SpO2<80%发生率差异无统计学意义(P>0.05)。LISA组患者的SpO2低于InSurE组,第2、4分钟血压监测低于InSurE组,差异均有统计学意义(P<0.05)。LISA组患者治疗后1h的动脉血氧分压高于InSurE组,动脉血二氧化碳分压低于InSurE组,差异均有统计学意义(P<0.05)。LISA组患者72h内机械通气比例及氧疗时间均低于InSurE组、差异均有统计学意义(P<0.05)。两组患者的肺表面活性物质(pulmonary surfactant,PS)再利用率、住院时间比较,差异无统计学意义(P>0.05)。LISA组患者3~4级脑室旁-脑室内出血(periventricular intraventricular hemorrhage,P-IVH)发生率低于InSurE组,差异有统计学意义(P<0.05)。两组患者其他并发症发生率差异均无统计学意义(P>0.05)。结论微创法给予PS治疗极早产儿RDS可减少机械通气发生率、缩短氧疗时间、减少严重P-IVH的发生。Objective To observe clinical efficacy and safety of less invasive surfactant administration(LISA)in treatment of respiratory distress syndrome(RDS)in extremely premature infants.Methods A total of 65 cases premature infants diagnosed with RDS admitted to neonatal intensive care unit of Xiaogan Central Hospital from January 2021 to December 2023,with gestational age of 28+0~31+6 weeks.They were divided into LISA group(n=33)and intubation administration of surfactant extubation(InSurE)group(n=32)using a random number table method.The incidence of adverse events,blood gas analysis before and after administration,pulse oxygen saturation(SpO2),changes in blood pressure,clinical efficacy,complications,and outcomes were compared between two groups.Results There was no statistically significant difference in the incidence of drug reflux,bradycardia,apnea,or SpO2<80%between two groups of operations(P>0.05).During the operation,SpO2 of LISA group was lower than that of InSurE group,and blood pressure monitoring at the 2nd and 4th minutes were lower than those of InSurE group at the corresponding time points,with statistically significant differences(P<0.05).After 1 hour of treatment,arterial partial pressure of oxygen in LISA group was higher than that in InSurE group,and arterial partial pressure of carbon dioxide was lower than that in InSurE group,with statistically significant differences(P<0.05).The mechanical ventilation ratio and oxygen therapy time within 72 hours in LISA group were lower than those in InSurE group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in reuse rate of pulmonary surfactant(PS),and hospitalization time between two groups(P>0.05).The incidence of grade 3-4 periventricular intraventricular hemorrhage,P-IVH in LISA group was lower than that in InSurE group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence of other complications between two groups(P>0.05).Conc

关 键 词：呼吸窘迫综合征 极早产儿 肺表面活性物质 微创法 

分 类 号：R722.6[医药卫生—儿科]