早期雾化吸入布地奈德预防极低出生体质量儿支气管肺发育不良

Clinical study of early inhalation of Budesonide in the prevention of bronchopulmonary dysplasia in very low birth weight infants

目的探讨出生后早期雾化吸入布地奈德对极低出生体质量儿支气管肺发育不良（BPD）的预防作用及不良反应。方法采用前瞻性随机对照试验设计，收集南方医科大学附属深圳市妇幼保健院新生儿重症监护病房（NICU）于2015年7月15日至2016年12月25日收治的胎龄≥27周且〈32周或出生体质量≥1 000 g且〈1 500 g的BPD高危早产儿，共105例，采用随机数字表法分为3组：早期雾化组（34例）、晚期雾化组（34例）和未雾化组（37例）。比较3组患儿用氧时间及BPD、早产儿脑室周围-脑室内出血（IVH）、早产儿视网膜病（ROP）、新生儿坏死性小肠结肠炎（NEC）、早产儿动脉导管未闭（PDA）、脓毒症、高血糖的发生率。结果3组间平均用氧总天数，早期雾化组为9 d，晚期雾化组为15 d，未雾化组为18 d，早期雾化组明显低于晚期雾化组和未雾化组，差异有统计学意义（H＝6.09，P〈0.05）；3组间用氧时间，早期雾化组为3 d，晚期雾化组和未雾化组均为6 d，早期雾化组明显低于晚期雾化组及未雾化组，差异有统计学意义（H＝6.17，P〈0.05）。3组间BPD发生率，早期雾化组、晚期雾化组和未雾化组分别为14.7%（5/34例）、20.6%（7/34例）、37.8%（14/37例），未雾化组明显高于早期雾化组和晚期雾化组，差异有统计学意义（χ^2＝12.017，P〈0.05）。3组间在IVH、ROP、NEC、PDA、脓毒症、高血糖方面差异均无统计学意义（均P〉0.05）。结论对于BPD高危极低出生体质量儿，出生后早期雾化吸入布地奈德可降低BPD的发生率及用氧时间，且无明显近期不良反应。

ObjectiveTo investigate the preventive and adverse effects of postnatal inhalation of Budesonide in early stage on bronchopulmonary dysplasia （BPD） in very low birth weight infants.MethodsA total of 105 cases of high risk premature infants with BPD, who were born in the Neonatal Intensive Care Unit （NICU） from Shenzhen Maternity and Child Healthcare Hospital from July 15, 2015 to December 25, 2016, and their gestational age ≥27 weeks and 〈 32 weeks or birth weight ≥1 000 g and 〈1 500 g were collected for a prospective randomized controlled trial, and were randomly divided into 3 groups： early inhalation group（34 cases）, late inhalation group（34 cases） and non-inhalation group（37 cases）. The oxygen time, and the incidence of BPD, periventricular-intraventricular hemorrhage（IVH）, retinopathy of prematurity （ROP）, necrotizing enterocolitis of the newborns （NEC）, patent ductus arteriosus in preterm infants （PDA）, sepsis and hyperglycemia of infants in 3 groups were compared.ResultsThe average oxygen time in early inhalation group was 9 days, while in late inhalation group and the non-inhalation group was 15 days and 18 days, respectively.The average oxygen time in early inhalation group was significantly lower than that in the late inhalation group and the non-inhalation group, with the difference being statistically significant （H=6.09, P〈0.05）. The noninvasive ventilation time in early inhalation group was 3 days, while both the late inhalation group and non-inhalation group were 6 days.The noninvasive ventilation time in early inhalation group was significantly lower than that in the late inhalation group and non-inhalation group, with the difference being statistically significant （H=6.17, P〈0.05）. The incidence of BPD in the early inhalation group, late inhalation group and non-inhalation group were 14.7%（5/34 cases）, 20.6%（7/34 cases） and 37.8%（14/37 cases）, respectively.The incidence of BPD in non-inhalation group was significantly higher than that in the early inhalation group and late inhalation group, with the diffe-rence being statistically significant （χ^2=12.017, P〈0.05）. There were no significant differences in IVH, ROP, NEC, PDA, sepsis and hyperglycemia among the 3 groups （all P〉0.05）.ConclusionsPostnatal inhalation of Budesonide in early stage in high risk very low birth weight infants can reduce the incidence of BPD and the oxygen time, and the adverse reactions are not obvious.