INSURE策略治疗新生儿呼吸窘迫综合征的临床研究

Clinical effectiveness of INSURE method in the treatment of neonatal respiratory distress syndrome

目的研究气管插管-肺表面活性物质(PS)-拔管使用鼻塞式气道正压通气(INSURE)策略治疗新生儿呼吸窘迫综合征(NRDS)的有效性和安全性,以及减少肺损伤机制的初步探讨。方法将2010年3月至2012年3月入院并同意使用PS的NRDS患儿64例随机采用INSURE治疗(观察组)和常频通气(CMV)治疗(对照组),每组各32例。比较两组呼吸功能、上机时间、用氧时间、合并症及转归,测定两组白介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)和血清铁蛋白(SF)的表达差异。结果治疗后48 h观察组氧合指数较对照组明显增高,差异有统计学意义(P<0.05)。观察组呼吸机相关性肺炎(VAP)发生率明显低于对照组(P<0.05),氧疗时间明显缩短(P<0.05)。两组上机时间、气胸、颅内出血、坏死性小肠结肠炎、支气管肺发育不良、肺出血的发生率差异无统计学意义(P>0.05)。观察组TNF-α和SF水平在6 h、24 h、48 h、72 h较对照组明显降低(P<0.05),IL-10水平较对照组明显增高(P<0.05)。结论 INSURE策略能更好地改善NRDS患儿氧合功能,减少VAP的发生率,缩短了用氧时间,这可能与其减少TNF-α、SF产生,抑制抗炎因子IL-10减少有关。

Objective To evaluate the clinical effectiveness and safety of intubation-surfactant-extubation （INSURE） method in the treatment of neonatal respiratory distress syndrome （ NRDS）, and to investigate its possible mechanisms. Methods Sixty-four premature infants, who were admitted for NRDS and treated with pulmonary surfactant from May 2009 to May 2012, were enrolled in the study. They were randomly divided into INSURE （n = 32） and conventional mechanical ventilation （CMV） groups （n = 32）. The two groups were compared in terms of respiratory function, ventilation time, duration of oxygen therapy, complications, and prognosis, as well as expression of interleukin-10 （IL-10）, tumor necrosis factor-a （TNF-a） and serum ferritin （SF）. Results Oxygenation index in the INSURE group was significantly higher than in the CMV group at 48 hours after treatment （P 〈 0.05）. Compared with the CMV group, the INSURE group showed significantly lower incidence of ventilator-associated pneumonia （VAP） and significantly shorter duration of oxygen therapy （P 〈0.05 for all comparisons）. There were no significant differences in ventilation time and the incidence oF pneumothorax, intracrania] hemorrhage, necrotizing enteroolitis, bronchopulmonary dysplasia, and pneumorrhagia between the two groups （P 〉 0.05）. The levels of TNF-a and SF were significantly lower in the INSURE group than in the CMV group at 6, 24, 48, and 72 hours after treatment （P〈0. 05）, while the level of IL-10 was significantly higher in the INSURE group than in the CMV group （P 〈0. 05）. Conclusions INSURE method can improve the oxygenation function of the lung, decrease the incidence of VAP and shorten the duration of oxygen therapy in neonates with NRDS, which is probably due to the fact that this method can reduce the production of TNF-a and SF and inhibit the decrease of IL-10.