肺表面活性物质对新生儿呼吸窘迫综合征患儿支气管肺发育情况的影响研究

Effect of pulmonary surfactant on bronchopulmonary development in neonates with respiratory distresssyndrome

目的研究肺表面活性物质（Ps）对新生儿呼吸窘迫综合征（NRDS）患儿支气管肺发育情况的影响。方法将本院自2012年1月至2013年12月收治的72例采用Ps治疗的72例NRDS患儿为观察组，按1：1比例筛选同期2012年1月至2013年12月收治的未行Ps治疗的72例NRDS患儿为对照组，比较两组患儿治疗前、治疗1周后的血气分析指标水平，并统计中转机械通气比例、辅助通气持续时长及支气管肺发育不良的发生率，并对所有患儿给予为期36个月的随访，统计再发呼吸系统疾病比例。结果治疗前，两组患者血气分析指标比较，差异无统计学意义（P〉0．05），治疗后，血气分析指标PaCO2、氧合指数（PaOJFiO2）水平显著改善，但观察组在治疗1周时，其血气分析指标的改善程度较对照组优；同时，观察组患儿中中转机械通气比例、辅助通气持续时长及支气管肺发育不良的发生率、再发呼吸系统疾病比例依次为6．94％、（10．124-0．34）d、2．78％、16．67％，较对照组19．44％、（14．97±1．66）d、13．88％、34．72％低；经上述指标行组内或组间对比，差异均有统计学意义（均P〈0．05）；且观察组患儿不良反应发生率仅为1．38％，略低于对照组的2．78％，但对比差异无统计学意义（P〉0．05）。结论Ps用于NRDS患儿不仅能有效纠正其血气分析指标，还能缩短辅助机械通气时长，减少中转机械通气比例，还能降低治疗后再发呼吸系统疾病的发生风险，对患儿支气管肺功能的远期疗效不容忽视。

Objective To investigate the effect of pulmonary surfactant （PS） on bronchopulmonary development in neonates with respiratory distress syndrome （NRDS）. Methods 72 neonates with NRDS treated with PS in our hospital from Jan. 2012 to Dec. 2013 were selected as observation group, and another 72 neonates with NRDS treated without PS in our hospital from Jan. 2012 to Dec. 2013 were selected as control group. The indexes of blood gas analysis before treatment and one week after treatment were compared between the two groups, and the rate of transit mechanical ventilation, the duration of assisted ventilation, and the incidence of bronchopulmonary dysplasia in the two groups were calculated. All the patients were followed up for 36 months, and the recurrence rate of respiratory diseases was statistically recorded. Results Before treatment, there were no statistically significant differences in blood gas analysis indexes between the two groups （P〉0.05）; one week after treatment, the blood gas analysis indexes [PaCO2, oxygenation index （PaOJFiO2）] significantly improved, the improvement in the observation group was better than that in the control group. The rate of transit mechanical ventilation, the duration of assisted ventilation, the incidence of bronchopulmonary dysplasia, and the recurrence rate of respiratory diseases in the observation group were 6.94%, （10.12~0.34）d, 2.78%, 16.67%, lower than those in the control group [19.44%, （14.97~1.66）d, 13.88%, 34.72%], with statistically significant differences （P〈0.05）. The incidence of adverse reactions in the observation group was only 1.38%, slightly lower than that in the control group （2.78%）, without statistically significant difference （P〉O.05）. Conclusions PS can effectively rectify the blood gas analysis indexes in neonates with respiratory distress syndrome, shorten the duration of assisted mechanical ventilation, reduce the rate of transit mechanical ventilation and the risk of recurrent respiratory diseases, whose long-term curative effect on bronchopulmonary function in neonates should not be neglected.