肺表面活性物质预防早产儿呼吸窘迫综合征的疗效评价

Efficacy of pulmonary surfactant for prevention of neonatal respiratory distress syndrome of preterm infants

目的评价肺表面活性物质（pulmonary surfactant，PS）预防早产儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）的疗效。方法95例胎龄为28～34周早产儿，均给予保暖、通畅呼吸道、吸氧、呼吸机辅助呼吸、控制感染、防治出血等常规治疗的基础上，按照家长对PS的使用意见分为两组。观察治疗组45例，出现典型临床表现确诊为NRDS后使用PS，若未出现典型临床表现，则不使用PS；预防使用组50例，全部在出生后30分钟内，无论有无NRDS的临床表现均使用PS。比较两组患儿NRDS发生率、胸部X射线、辅助呼吸时间、并发症率和病死率。结果预防使用组的NRDS发生率（38．00％）明显低于观察治疗组（75．56％），确诊病例较观察治疗组的胸片分级低，辅助呼吸时间短，差异均有统计学意义（P〈0．05）。两组并发症发生率及病死率差异无统计学意义（P〉0．05）。结论与观察确诊后才使用PS相比，早期预防使用PS能够减少NRDS的发生率，降低胸片分级，缩短辅助呼吸时间。

Objective To evaluate the effects of pulmonary surfactant（PS） for prevention of neonatal respiratory distress syndrome （NRDS） of preterm infants, Methods Clinical data of 95 preterm infants with gestational age ranged from 28 to 34 weeks were retrospectively analyzed. All eases were given a conventional treatment, such as a warm, airway patency, oxygen supply, mechanical ventilation, infection control and prevention or controlling hemorrhage. The infants were divided into observation group（ n = 45 ）and prevention group（ n =50）according to the decision of the parents. In the observation group,PS was given when the typical clinical manifestations were diagnosed as NRDS, otherwise no PS was applied. In the prevention group PS was administrated after 30 min of birth regardless of the clinical manifestations of NRDS. The incidence of NRDS, chest X ray examination, time of mechanical ventilation, complica- tion and mortality rate were compared between the two groups. Results The incidence of NRDS in the prevention group（38.0% ）was significantly lower than that in the observation group（75.56% ）. In the NRDS confirmed cases, grade of chest X-ray was lower and time of mechanical ventilation was longer in the observation group than that in the prevention group（ all P 〈 0. 05 ）. No significant difference in the rates of complications and mortality between the two groups. Conclusion Early administration of PS for prevention of NRDS can reduce the diseases incidence,lower the grade of chest X-ray, shorten the time of mechanical ventilation in NRDS cases. However, the complication rate and mortality have not been significantly improved yet.