早产双胎儿呼吸窘迫综合征的防治

Prevention and treatment of respiratory distress syndrome in premature twins

目的 观察地塞米松联合肺表面活性物质(PS)防治早产双胎儿呼吸窘迫综合征(RDS)的疗效。方法 12对24例早产双胎儿,按出生先后顺序分为第一出生双胎儿组(FBG)和第二出生双胎儿组(SBG)。胎儿出生前所有孕妇均静脉注射地塞米松,双胎儿出生后4h左右均向气管注入肺表面活性物质观察用药剂量和用药后胎儿血气变化,RDS的发生情况及其转归。结果 FBG和SBG平均应用PS的量分别为(77. 3±20. 7)mg/kg和(76. 2±15. 0)mg/kg, (t=0. 45,P>0. 05)。两组需氧时间分别为(8. 0±7. 1)和(8. 4±7. 3)d,各有1例需氧超过28d。PS注入前后两组组内对比,pH和PaO2 差异显著,显示低氧血症和酸中毒纠正。RDS发生率FBG为25%,SBG为50%;存活率分别为100%和91. 67%,总存活率95. 83%结论 孕妇产前应用地塞米松和胎儿出生后使用PS能降低早产双胎儿RDS的发生率,提高生存率;PS对RDS有治疗作用。

Objective To explore the role of dexamethasone with pulmonary surfactant(PS) in treating respiratory distress syndrome(RDS) of premature twins.Methods 12 twins (24 cases) were divided into first-born group (FBG) and second-born group (SBG).Dexamethasone was injected intravenously to mother before delivery and PS was injected through trachea to premature twins within 4h after birth.Administration dosage and blood gas changes were observed after administration.The incidence of RDS and transferring was monitored.Results The volumes of PS in FBO and SBG groups were (77.3±20.7) mg/kg and (76.2±15.0) mg/kg,respectively (t=0.45,P>0.05).The time for oxygen was (8.0±7.1) days and (8.4±7.3) days in the two groups.1 case of each group needed oxygen for over 28 days.There were obvious differences in pH and PaO 2 between groups before and after PS injection,indicting the adjustment of hypoxemia and acidosis.The incidences of RDS in FBG and SBG group were 25% and 50%,respectively.The survival rates were 100% and 91.67%,respectively in the two groups,with the overall survival rate of 95.83%.Conclusion Prenatal application of dexamethasone and postnatal PS can reduce the incidence of RDS and increase the survival rate.PS can treat RDS effectively.