乌司他丁辅助防治早产儿支气管肺发育不良的疗效

Effects of prophylactic auxiliary usage of ulinastatin on neonatal bronchopul-monary dysplasia

目的探讨乌司他丁辅助防治早产儿支气管肺发育不良(BPD)的临床价值。方法胎龄32周以下、体重1 500 g以下、需有创机械通气的新生儿呼吸窘迫综合征(NRDS)患儿112例,随机分为两组,每组56例。对照组予外源性肺表面活性物质(PS)替代治疗加气管插管肺保护性机械通气治疗,以及限制液体、控制感染、营养支持治疗,后逐步调整、撤离呼吸机,改用持续正压通气(CPAP)呼吸支持,病情稳定后逐步停氧。乌司他丁组在对照组治疗方案的基础上加用乌司他丁10 000 U·kg^(-1)·d^(-1),疗程3周。比较两组BPD发生率,机械通气、CPAP辅助通气、总用氧时间,并观察不良反应发生情况。结果乌司他丁组完成治疗50例,对照组完成47例。乌司他丁组BPD发生率4%(2/50),低于对照组[21%(10/47),P<0.05]。乌司他丁组机械通气、CPAP辅助通气、总用氧时间分别为(103.7±18.7)、(153.2±16.3)、(478.5±38.1)h,均低于对照组[(147.6±19.3)、(201.8±74.7)、(597.4±97.5)h,P<0.05]。未见明显不良反应发生。结论乌司他丁可以减少NRDS患儿的机械通气、CPAP辅助通气和总用氧时间,可能对防治BPD有效。

AIM To evaluate the effects of ulinastatin on the prevention of neonatal bronchopul-monary dysplasia （BPD）. METHODS One hundred and twelve infants with neonatal respiratory distress syndrome （NRDS） were enrolled, with the gestational age under 32 weeks, weight below 1 500 g and need invasive mechanical ventilation. The infants were randomly divided into two groups （n = 56 in each） . All infants were given exogenous pulmonary surfactant （PS） replacement therapy and endotracheal intubation lung protective mechanical ventilation treatment, fluid restriction, infection control and nutritional support. The breathing machine was withdrawn gradually and continuous positive airway pressure （CPAP） support was used. Oxygen uptake was stopped gradually after infants in stable condition. And infants in the ulinastatin group were given ulinastatin 10 000 U· kg^-1·d^-1 for 3 weeks. After the treatment, the mechanical ventilation time, CPAP assisted ventilation time, total time with oxygen and the incidence of BPD were compared between two groups. The adverse reactions were also observed. RESULTS There were 50 infants completed the treatment in the uliriastatin group and 47 infants in the control group. The incidence of BPD was 4% （2/50） in the ulinastatin group, lower than that in the control group （21% （10/47）, P 〈 0.05） . The mechanical ventilation time, CPAP assisted ventilation time and total time with oxygen were （103.7 ±18.7）, （153.2 ±16.3） and （478.5 ±38.1） h in the ulinastatin group, lower than those in the control group （（147.6 ±19.3）, （201.8 ±74.7） and （597.4 ±97.5） h, P 〈 0.05） . No obvious adverse reaction occurred. CONCLUSION Ulinastatin can reduce the mechanical ventilation time, CPAP assisted ventilation time and total time with oxygen, and may be effective for the prevention and treatment of BPD.