肺表面活性物质不同首剂量对近足月新生儿呼吸窘迫综合征疗效的影响

Influence of Different Primary Dose of Pulmonary Surfactant on Near-Term Infants with Neonatal Respiratory Distress Syndrome

目的:探讨不同首剂量应用肺表面活性物质(PS)对近足月新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性。方法:选择我院2011年7月至2016年7月收治的近足月NRDS患儿共90例,以随机区组法分为A、B、C三组各30例,分别给予PS首剂量40、70、90 mg/kg辅助治疗,比较三组患儿的机械通气时间、供氧时间、住院时间、PS重复给药次数及治疗前后PaO_2、PaCO_2、OI和肺部X线片评分、院内肺炎发生率。结果:三组患儿机械通气时间、供氧时间、住院时间、PS重复给药次数、院内肺炎发生率及治疗后的PaCO_2、OI和肺部X线片评分排序为C组<B组<A组(P均<0.05)。三组患儿治疗后PaO_2、PaCO_2、OI及肺部X线评分均优于治疗前(P均<0.05);三组患儿治疗后PaO_2比较差异无统计学意义(P>0.05)。结论:PS首剂量90 mg/kg应用于近足月NRDS,可有效缩短机械通气时间和住院时间,减少PS重复给药次数,提高肺部通气功能,有助于避免院内肺炎发生风险,临床价值优于40 mg/kg和70 mg/kg。

Objective： To investigate the influence of different primary dose of pulmonary surfactant（ PS） on near-term infants with neonatal respiratory distress syndrome（ NRDS）. Methods： Ninety near-term infants with NRDS were chosen in our hospital from July2011 to July 2016,they were randomly divided into 3 groups including group A（ 30 children） with primary dose of PS for 40 mg/kg,group B（ 30 children） with primary dose of PS for 70 mg/kg and group C（ 30 children） with primary dose of PS for 90 mg/kg. The mechanical ventilation time,oxygen used time,hospitalization time,PS administration times,the levels of PaO2,PaCO2,OI before and after treatment,pulmonary X-ray score,pneumonia incidence of 3 groups were compared. Results： The mechanical ventilation time,oxygen used time,hospitalization time of group C were significantly shorter than group A and group B（ P〈0. 05）,and the group B were significantly shorter than group A（ P〈0. 05）. The PS administration times and pneumonia incidence of group C were significantly fewer than group A and group B（ P〈0. 05）,and the group B were significantly fewer than group A（ P〈0. 05）. The levels of PaO2,PaCO2,OI after treatment,and pulmonary X-ray score of group C were significantly better than group A and group B,3 groups were significantly better than before treatment（ P〈0. 05）. There was no significant difference in the PaO2 level after treatment among 3 groups（ P〈0. 05）.Conclusion： Compared with primary dose of PS for 40mg/kg and 70 mg/kg,primary dose of PS for 90 mg/kg in the treatment of nearterm infants with NRDS can efficient shorten the ventilation time and hospital staying time,reduce the dosage of PS once again,the pulmonary ventilation function and be helpful to avoid the risk of pneumonia.