肺表面活性物质联合布地奈德对急性呼吸窘迫综合征极低出生体质量儿肺功能的影响

Effect of Using Pulmonary Surfactant Mixed with Budesonide on Pulmonary Function in Very Low Birth Weight Premature with Acute Respiratory Distress Syndrome

目的探讨肺表面活性物质(PS)联合布地奈德对急性呼吸窘迫综合征(ARDS)极低出生体质量儿肺功能的影响,并评价联合用药的治疗效果。方法 2010年8月-2011年3月南京市妇幼保健院收治的胎龄<34周、出生体质量<1 500 g、出生4 h内发生ARDS的早产儿30例,随机分为PS组和PS+布地奈德组。PS+布地奈德组(男9例,女6例)使用PS和布地奈德混合剂(每70 mg PS中加入0.25 mg布地奈德),剂量:PS 70 mg.kg-1,布地奈德0.25 mg.kg-1。PS组(男8例,女7例)单使用PS,70 mg.kg-1,出生30～60 min内由气管内滴入。监测2组患儿血气及肺功能。结果 PS+布地奈德组患儿动脉血气pH值第2、5、6天明显高于PS组(Pa<0.05),二氧化碳分压[pa(CO2)]第3、4、6天明显降低(Pa<0.05),氧合指数(OI)第3、4、6天明显升高(Pa<0.05);肺功能监测2组胸肺总顺应性(Crs)升高、呼吸道阻力(Raw)下降、潮气量(TV)增加,第5、6天与PS组比较有显著差异(Pa<0.05)。结论使用PS联合布地奈德对ARDS极低出生体质量儿能较快改善肺功能,尽早撤离呼吸机,减少肺损伤,减少早产儿支气管肺发育不良的发生。

Objective To explore the influence of pulmonary function in very low birth weight premature with acute respiratory distress syndrome（ARDS） after using pulmonary surfactant（PS） mixed with budesonide,and evaluate the therapeutic effect of combination. Methods Thirty premature infants with gestational age 34 weeks,birth weight 1 500 g,whose ARDS occurred within 4 hours after birth,were randomly assigned into the PS group and PS＋budesonide group in Nanjing Maternal and Child Health Hospital from Aug.2010 to Mar.2011.PS mixture and budesonide were used in PS＋budesonide group（9 male and 6 female）（Per 70 mg PS adding budesonide 0.25 mg）,PS dose 70 mg·kg-1,budesonide dose 0.25 mg·kg-1.PS group（8 male and 7 female） only with PS,dose 70 mg·kg-1.By intratracheal after birth 30 to 60 minutes and monitoring of blood gas and lung function in both groups. Results pH value of arterial blood gas in PS＋budesonide group was significantly higher than that in PS group on the 2,5,6 day（Pa0.05）;and carbon dioxide partial pressure [pa（CO2）] was significantly lower on the 3,4,6 day（Pa0.05）;and oxygenation index（OI） significantly increased on the 3,4,6 day（Pa0.05）.Lung compliance（Crs） increased,and lung resistance（Raw） decreased,and tidal volume（TV） increased in 2 groups through monitoring lung function,and PS＋budesonide group had significant difference compared with the PS group on the 5,6 day（Pa0.05）. Conclusions Lung function can be quickly improved in very low birth weight premature with ARDS after using PS mixed with budesonide.Ventilator should be withdrawn as soon as possible so as to reduce lung injury and reduce the incidence of bronchopulmonary dysplasia in preterm infant.