肺表面活性物质治疗新生儿呼吸窘迫综合征的临床对照研究

Surfactant replacement therapy in neonates with respiratory distress syndrome

目的 探讨肺表面活性物质 (PS)治疗新生儿呼吸窘迫综合征 (NRDS)的有效性及临床价值。方法 采用气管内滴注单剂PS治疗NRDS患儿 2 5例 ,并与同期未用PS治疗的 2 5例NRDS患儿进行前瞻性临床对照研究。结果 治疗组在应用PS后 2～ 3h皮肤颜色转红 ,经皮血氧饱和度逐渐升高。 6h后动脉血氧分压 (PaO2 )、动脉 /肺泡血氧分压比值 (a/APO2 )及呼吸机有效指数 (VEI)分别由 ( 48± 14)mmHg( 1mmHg =0 .133kPa)、0 .14± 0 .0 6及 ( 0 .16± 0 .0 9)ml/ (mmHg·kg)上升到 ( 6 5±2 9)mmHg、0 .2 4± 0 .15及 ( 0 .2 9± 0 .16 )ml/ (mmHg·kg) ;而氧合指数 (OI)、吸入氧浓度 (FiO2 )及平均气道压 (MAP)由 11.6± 5 .7、0 .5 9± 0 .13及 ( 15 .6± 3.1)cmH2 O( 1cmH2 O =0 .0 98kPa)逐渐降低至 6 .3±3 .4、0 .47± 0 .10及 ( 13 .5± 2 .4)cmH2 O。经广义线性模型方差分析 ,主效应、分组因素及时间因素对两组PaO2 、a/APO2 、OI、FiO2 、MAP及VEI的值具有明显影响。而分组与时间因素的交互作用无显著影响。治疗组机械通气及氧疗时间较对照组明显缩短 ,二者差异有显著性。结论 PS能有效地改善NRDS患儿肺顺应性及氧合功能 ,缩短需要机械通气及氧疗时间。

Objective To study the efficacy and clinical value of pulmonary surfactant (PS)replacement therapy in newborn infants with respiratory distress syndrome(NRDS). Method The study was a prospective controlled clinical trial. Twentyfive neonates with NRDS were treated with single dose pulmonary surfactant by intratracheal administration and an other twentyfive newborn infants with NRDS who received no surfactant replacement therapy were enrolled as control group between April 1996 and August 1998. Results Hypoxemia in the patients of PS treated group was markedly relieved within 2 to 3 hours after administration of surfactant, values for arterial partial pressure of oxygen(PaO 2), arterial oxygen/alveolar oxygen ratio(a/A P0 2) and ventilator efficiency index(VEI) significantly increased from (48±14)mm Hg(1 mm Hg=0.133 kPa),0.14±0.06 and (0.16±0.09) ml/(mm Hg·kg) to (65±29)mm Hg,0.24±0.15 and (0.29±0.16) ml/(mm Hg·kg), but oxygenation index(OI), fraction of inspired oxygen(FiO 2), and mean airway pressure(MAP) decreased gradually from 11.6±5.7, 0.59±0.13 and (15.6±3.1) cm H 2O(1 cm H 2O=0.098 kPa) to (6.3±3.4), 0.47±0.10 and( 13.5±2.4)cm H 2O after 6 hours of administration. Main effects, group and treatment time had marked effects on values of PaO 2,a/A PO 2,OI、FiO 2,MAP and VEI in the two groups, but 2 way interactions between group and treatment time had no effect on them by analysis of general linear model and LSD test. Duration of assisted ventilation and supplemental oxygen administration in PS treated group was significantly shortened as compared to control group. Conclusion The results indicate that surfactant replacement therapy may result in a rapid improvement in dynamic compliance and oxygenation, and decrease duration of assisted ventilation and supplemental oxygen administration in the newborns with NRDS.