影响INSURE技术治疗早产儿呼吸窘迫综合征 疗效因素的临床分析

The clinical analysis of the factors influencing the therapeutic effect of INSURE technology in premature infants with respiratory distress syndrome

目的探讨影响以INSURE技术治疗早产儿呼吸窘迫综合征(NRDS)效果的相关因素。方法回顾性分析2009年1月至2012年12月新生儿重症监护病房中309例以INSURE技术治疗的NRDS患儿的临床资料。结果 309例NRDS患儿中治愈出院302例,总治愈率97.7%;21例(6.8%)在72 h内需要再次气管插管予机械通气;不同出生胎龄患儿的再插管通气率差异有统计学意义(P<0.01),其中≤28周患儿的再插管率较高。根据是否需要再插管通气分为成功组和失败组,与成功组比较,失败组胎龄≤28周、出生体质量<1 000 g、病情严重患儿较多,应用肺表面活性物质(PS)剂量和PS重复使用率较高,需要氧气支持比例高,病死率高,差异均有统计学意义(P<0.05)。结论 INSURE技术可有效用于临床治疗NRDS患儿,胎龄小、出生体质量低、病情严重是导致INSURE技术失败的重要原因。

Objective To assess the factors influencing the therapeutic effects of INSURE technology in premature in- fants with respiratory distress syndrome （NRDS）. Methods The clinical data from 309 infants with NRDS treated by INSURE technology were retrospectively analyzed from Jan. 2000 to Dec. 2012. Results In 309 infants with NRDS, 302 infants were cured and the cure rate was 97.7%. Twenty-one infants （6.8%） needed the reintubation for mechanical ventilation within 72 h. The difference in reintubation rate was statistically significant among infants with different gestational age （P〈0.01）. The infants with the gestation age ≤ 28 weeks had a significantly higher reintubation rate. According to whether the reintubation was performed, the infants were divided into success group and failure group. Compared to the success group, there were higher percentage of infants who had gestation age ≤ 28 weeks, birth weight 〈1000 g and severe NRDS, needed high dose and repeated use of pulmonary surfactant and oxygen therapy, and had higher mortality in the failure group had （all P〈0.05）. Conclusions The INSURE technology can be effective in treatment of NRDS. Small gestational age, low birth weight, and severe NRDS are the risk factors for the failure of the INSURE technology.