肺表面活性物质联合布地奈德干预治疗对伴呼吸窘迫综合征的低出生体质量儿心功能的保护作用

Protection of Pulmonary Surfactant Combined with Budesonide on Heart Function of Very Low Birth Weight Premature with Respiratory Distress Syndrome

目的探讨肺表面活性物质(PS)联合布地奈德对伴呼吸窘迫综合征(RDS)的极低出生体质量儿(VLBWI)心功能的保护作用,并评估联合用药的效果。方法选取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RDS的早产儿30例,将其随机分为PS+布地奈德组和PS组。PS+布地奈德组使用PS和布地奈德混合剂(每70 mg PS中加入0.25 mg布地奈德),PS剂量70 mg.kg-1,布地奈德0.25 mg.kg-1。PS组单使用PS,剂量70 mg.kg-1。在出生30～60 min由气管内滴入。于1、7、14 d进行血清CK-MB和肌钙蛋白测定,同时进行超声心动图检查,对左心室射血分数(LVEF)、右心室射血分数(RVEF)、二尖瓣舒张早期和舒张晚期血流峰比值(MVE/A)、三尖瓣舒张早期和舒张晚期血流峰比值(TVE/A)、左心室(LV)-Tei指数进行测定。结果 PS+布地奈德组血清CK-MB和肌钙蛋白14 d低于PS组(Pa<0.05);与PS组比较,PS+布地奈德组心脏收缩功能LVEF 14 d明显增加(P<0.05),RVEF 7、14 d均明显增加(Pa<0.05)。2组MVE/A和TVE/A均逐渐增加,PS+布地奈德组增加明显,MVE/A 14 d,TVE/A 7、14 d与PS组比较差异有统计学意义(Pa<0.05)。PS+布地奈德组LV-Tei指数14 d低于PS组(P<0.05)。结论使用PS联合布地奈德对伴RDS的VLBWI进行干预对其心脏具有保护作用,可促进心脏功能恢复。

Objective To explore the heart protection in very low birth weight premature infants with respiratory distress syndrome （RDS） after using budesonide combined with pulmonary surfactant （PS） , and evaluate the therapeutic effect of combination of budesonide and PS. Methods Thirty premature infants with gestational age 〈 34 weeks,birth weight 〈 1 500 g and RDS within 4 hours after birth were randomly divided into the PS ＋ budesonide group and PS group ,who were hospitalized in Maternal and Child Health Hospital of Nanjing form Aug. 2010 to Mar. 2011. PS and budesonide were used in PS ＋ budesonide group （ per 70 mg PS adding budesonide 0.25 mg） ,in which IX3 dose was 70 mg· kg-1,and budesonide dose was 0.25 mg· kg-1. Patients in PS group only used PS,in which dose was 70 mg · kg-1. Tra- cheal inhalation of PS or PS ＋ budesonide was performed in both groups 30 to 60 minutes after births. Serum creatine kinase myocardial isoenzyme （CK- MB） and troponin were detected in both groups in 1 day,7 days and 14 days. Cardiac functions were evaluated by using echocardiography, and the parameters included left ventricular ejection fraction （LVEF）, right ventricular ejection fraction （RVEF）, ratio of peak E velocity and peak A velocity of mitral flow and tricuspid flow（ MVE/A and TVE/A） and LV - Tei index. Results CK - MB and tro- ponin in PS ＋ budesonide group were significantly lower than those in the control group on the 14th day（ P 〈 0.05 ） ;and LVEF was significant- ly higher on the 14th day（P 〈 0.05） ;and RVEF was significantly higher on the 7th day, 14th day（P 〈 0.05）. MVE/A and TVE/A were in- creased in both groups. But, PS ＋ budesonide group had significant differences compared with the PS group of MVE/A on the 14th day （MVE/ A ）, and TVE/A on the 7th day and 14th day（ Pa 〈 O. 05 ）. LV - Tei index in PS ＋ budesonide group was significantly lower （ P 〈 0.05 ）. Con- clusions Cardiac function can be quickly improved in very low birth weight premature infants with RDS after using budesonide and PS.