雾化吸入布地奈德和肺表面活性物质预防支气管肺发育不良的临床研究

Aerosol Inhalation of Budesonide and Pulmonary Surfactant to Prevent Bronchopulmonary Dysplasia

目的:探讨在机械通气的基础上雾化吸入布地奈德混悬液和肺表面活性物质(PS)预防支气管肺发育不良(BPD)的疗效,并观察不良反应。方法:选择120例早产儿随机分为三组,试验组采用布地奈德混悬液0.25 mg/kg和PS 100 mg/kg混合液雾化吸入联合机械通气治疗,对照组1采用PS 100 mg/kg气管插管内滴入联合机械通气治疗,对照组2采用PS 100 mg/kg雾化吸入联合机械通气治疗。检测三组患儿呼吸机平均气道压力(MAP)、氧合指数(OI)、血气分析pH值、氧分压(PaO_2)、二氧化碳分压(PaCO_2)、支气管肺泡灌洗液(BALF)中巨噬细胞移动抑制因子(MIF)和磷脂转运蛋白(PLTP)的含量,比较三组患儿拔管时间、需氧时间、平均住院时间,高血糖、动脉导管未闭(PDA)、脑室内出血(IVH)和早产儿视网膜病变(ROP)的发生率,BPD发生例数和死亡例数。结果:治疗后三组患儿PaO_2、PaCO_2及pH比较差异无统计学意义(P>0.05);三组患儿MAP、OI比较差异有统计学意义(P<0.01);三组患儿MIF和PLTP比较差异有统计学意义(P<0.01)。试验组MIF含量在各时间点均低于两个对照组,PLTP含量在各时间点均高于两个对照组,差异有统计学意义(P<0.01);试验组与两个对照组比较,BPD发生率、拔管时间、需氧时间、住院时间明显较低,差异有统计学意义(P<0.05);三组患儿病死率、高血糖、PDA、IVH和ROP的发生率比较差异无统计学意义(P>0.05)。结论:对有BPD患病高风险的早产儿,早期联合雾化吸入布地奈德混悬液和PS可降低BPD的发生率,达到早期预防的效果,且未发现不良反应。

Objective： To investigate the effect of the aerosol inhalation of budesonide combined with pulmonary surfactant（ PS） basis on the mechanical ventilation in treatment of bronchopulmonary dysplasia（ BPD） and observe the drug adverse reactions. Methods：One hundred and twenty preterm infants were involved in this study,and were randomly divided into 3 groups. The treated group was given a mixture of budesonide suspension（ 0. 25 mg/kg） and PS（ 100 mg/kg） aerosol inhalation combined with mechanical ventilation.The control group 1 received PS（ 100 mg/kg） intratracheal instillation combined with mechanical ventilation. The control group 2received PS（ 100 mg/kg） aerosol inhalation combined with mechanical ventilation. Mean airway pressure（ MAP）,oxygenation index（ OI）,pH,arterial oxygen tension（ PaO2）,arterial carbon dioxide tension（ PaCO2）,the contents of macrophage migration inhibitory factor（ MIF） and phospholipid transfer protein（ PLTP） in bronchoalveolar lavage fluid（ BALF） were detected. The time of extubated,duration of supplemental oxygen,duration of hospitalization,the incidence of hyperglycemia,patent ductus arteriosus（ PDA）,intraventricular hemorrhage（ IVH）,retinopathy of prematurity（ ROP） and the BPD occoured and death cases were compared. Results：There were no significant differences between the three groups of PaO2,PaCO2,and pH（ P〈0. 05）. There were significant differences between the three groups of MAP,OI,MIF and PLTP（ P0. 01）. The content of MIF in the treated group was significantly lower than the two control groups at each time point,while the content of PLTP was higher（ P〈0. 01）. The incidence of BPD,the time of extubation,duration of supplemental oxygen and hospitalization in treated group were significantly lower in the treated group than control groups（ P〈0. 05）. The motality,the incidence of hyperglycemia,PDA,IVH and ROP in these three groups were no significant differences（ P〉0. 05）. Conclusion： Combined aerosol inhalation of budesonide suspension and PS can reduce the incidence of BPD in preterm infants in early stage,and there are no drug adverse reactions detected.