早期不同剂量牛肺表面活性物质治疗晚期早产/足月新生儿呼吸窘迫综合征的临床疗效比较研究

Comparative Study for Clinical Effect of Different Doses of Bovine Pulmonary Surfactant on Early Neonatal Respiratory Distress Syndrome in Late Preterm Infants and Full-term Infants

目的比较早期不同剂量牛肺表面活性物质治疗晚期早产/足月新生儿呼吸窘迫综合征(NRDS)的临床疗效,以探讨牛肺表面活性物质的最佳治疗剂量。方法选取2012年2月—2015年10月在成武县人民医院确诊的晚期早产/足月NRDS患儿72例,按照随机数字表法分为研究组和对照组,每组36例。对照组患儿在常规治疗基础上给予常规剂量(50 mg/kg)牛肺表面活性物质进行治疗,研究组患儿在常规治疗基础上给予高剂量(70 mg/kg)牛肺表面活性物质进行治疗。比较两组患儿临床疗效、治疗情况〔机械通气时间、吸氧时间、治疗期间氧合指数最高值、肺表面活性物质(PS)二次使用率、住院时间、医疗费用〕及并发症发生情况。结果经治疗研究组患儿治愈35例,死亡1例;对照组患儿治愈34例,死亡2例。两组患儿临床疗效比较,差异无统计学意义(P>0.05)。研究组患儿机械通气时间和住院时间短于对照组,医疗费用低于对照组(P<0.05);两组患儿吸氧时间、治疗期间氧合指数最高值及PS二次使用率比较,差异无统计学意义(P>0.05)。两组患儿气漏综合征、肺动脉高压及肺出血发生率比较,差异无统计学意义(P>0.05);研究组患儿呼吸机相关性肺炎发生率低于对照组(P<0.05)。结论早期给予高剂量(70 mg/kg)和常规剂量(50 mg/kg)牛肺表面活性物质治疗晚期早产/足月NRDS的临床疗效相当,但高剂量(70mg/kg)牛肺表面活性物质能缩短患儿机械通气时间、住院时间,降低呼吸机相关性肺炎的发生风险,减轻医疗经济负担。

Objective To compare the clinical effect of different doses of bovine pulmonary surfactant on early neonatal respiratory distress syndrome in late preterm infants and full- term infants,to analyze the best therapeutic dose of bovine pulmonary surfactant. Methods A total of 72 late preterm infants and full- term infants with early neonatal respiratory distress syndrome were selected in the People＇s Hospital of Chengwu County from February 2012 to October 2015,and they were divided into control group and study group according to random number table,each of 36 cases. Based on conventional treatment,infants of control group were given standard dose of bovine pulmonary surfactant（ 50 mg / kg）,while infants of study group were given high dose of bovine pulmonary surfactant（ 70 mg / kg）. Clinical effect, treatment related index（ including duration of mechanical ventilation and oxygen inhalation, the maximum oxygenation index during treatment, reuse rate of pulmonary surfactant,hospital stays and medical expenses） and incidence of complications were compared between the two groups. Results Of study group,35 cases were cured,1 case was dead; of control group,34 cases were cured,2 cases were dead, no statistically significant differences of clinical effect was found between the two groups（ P〉0. 05）. Duration of mechanical ventilation and hospital stays of study group were statistically significantly shorter than those of control group,medical expenses of study group were statistically significantly less than those of control group（ P〈0. 05）, while no statistically significant differences of duration of oxygen inhalation, the maximum oxygenation index during treatment or reuse rate of pulmonary surfactant was found between the two groups（ P〉0. 05）. No statistically significant differences of incidence of gas leakage syndrome,pulmonary hypertension or pneumorrhagia was found between the two groups（ P〉0. 05）, while incidence of ventilator- associated pneumonia of study group was statistically significantly lower than that of control group（ P〈0. 05）.Conclusion Early use of high dose of bovine pulmonary surfactant（ 70 mg / kg） has similar clinical effect with standard dose of bovine pulmonary surfactant（ 50 mg / kg） in treating late preterm infants and full- term infants with neonatal respiratory distress syndrome,while high dose of bovine pulmonary surfactant（ 70 mg / kg） can more effectively shorten the duration of mechanical ventilation and hospital stays,reduce the risk of ventilator- associated pneumonia and medical economic burden.