应用糖皮质激素促进胎儿肺成熟对早产儿的影响

The Effect of Corticosteroid on Accelerating Fetal Lung Maturity in Premature Infants

目的探讨糖皮质激素在促进胎儿肺成熟治疗后对早产儿的影响。方法对早产儿58例(胎龄足28周至足34周)用糖皮质激素促进胎儿肺成熟治疗的设为治疗组30例,未作肺促成熟处理的设为对照28例。对两组患儿出生后的体格检查、免疫学相关指标和出现并发症情况进行统计学分析。结果治疗组早产儿在生后30d体重与对照组比较,差异有统计学意义(p<0.05);而头围、身长差异均无统计学意义(p>0.05);血清免疫球蛋白IgA、IgM测定治疗组比对照组低,差异有统计学意义(p<0.05,p<0.01),IgG则差异无统计学意义(p>0.05);在并发症方面,支气管肺发育不良(BPD)和视网膜病(ROP)发病率治疗组优于对照组,差异有统计学意义(p<0.05);早产儿不同程度脑室内出血发病率、新生儿坏死性小肠结肠炎(NEC)发病率治疗组较对照组均低,但差异无统计学意义(p>0.05)。结论糖皮质激素促胎肺成熟治疗成功降低了新生儿肺透明膜病发病率、病死率,并有明显的支气管肺发育不良预防作用,同时对ROP也有明显预防作用;可能对早产儿体格发育和体液免液产生一定的负面影响。

ObjectiveTo investigate the effect of corticosteroid on accelerating fetal lung ma- turity in premature infants. Methods 58 premature infants, between 28 and 34 weeks gestation, were randomly divided into corticosteroid group （n = 30） and control group （ n = 28 ）. The premature in- fants in the corticosteroid group were treated with dexamethasone to accelerate fetal lung maturity. Physical examination, immunological tests and complications between two groups were analyzed 30 days after birth. Rezults 30 days after birth, premature infants in corticosteroid group weighed much more than that in control group （W1 vs. W2, p 〈 0. 05 ） . There were no significant differences be- tween two groups in neither head circumference nor body length （p 〉0. 05 ）. The corticosteroid group had higher level of IgA （A1 vs. A2, p 〈 0. 05） and IgM （ M1 vs. M2, p 〈 0. 05 ）, while the differ- ence of IgG level was not significant （p 〉 0. 05 ）. There was lower risk of bronchopulmonary dysplasia （BPD） and retinopathy of prematurity （ROP） in corticosteroid group than in control group （B1 vs. B2, p 〈 0. 05 and R1 vs. R2 p 〈 0. 05 respectively）, but there were no significant differences of intraventricular hemorrhage and neonatal necrotizing enterocolitis （NEC） between two groups （p 〉 0. 03 ）. Conclusion Corticosteroid could reduce the morbidity and mortality of hyaline membrane disease （ HMD）, and could help to prevent BPD and ROP. Howerver, corticosteroid might have negative effects on physical development and humoral immunity.