微创肺表面活性物质治疗在新生儿呼吸窘迫综合征中的疗效与安全性

Effect and security of minimally invasive surfactant therapy in neonatal respiratory distress syndrome

目的探讨微创肺表面活性物质治疗（minimally invasive surfactant therapy，MIST）技术在新生儿呼吸窘迫综合征（NRDS）治疗中的应用效果和安全性。方法将2017年1月至2018年1月广州市妇女儿童医疗中心48例胎龄30～36周诊断为NRDS的早产儿采用随机数字表法分为MIST组（23例）和气管插管-使用肺表面活性物质-拔管使用持续呼吸道正压通气（INSURE）组（25例），MIST组在经鼻持续呼吸道正压通气（nCPAP）下经直接喉镜直视将细血管导管置于气管内并注入肺表面活性物质（PS）；INSURE组气管插管注入PS，拔管后行nCPAP。观察MIST组和INSURE组不良反应及并发症的发生率。结果MIST组和INSURE组患儿在给药过程中发生血氧饱和度（SpO2）下降（26.1%比36.0%）、心动过缓（13.0%比24.0%）、再次使用PS（8.7%比4.0%）等方面比较，差异均无统计学意义（均P〉0.05），出生72 h内均无需重新插管机械通气；MIST组和INSURE组的无创辅助通气时间[8 d（5.5～12.5 d）比7 d（5.0～14.0 d）]、总吸氧时间[12 d（7.0～26.5 d）比10 d（10.0～23.0 d）]及住院天数[（34.22±16.06） d比（30.88±14.35） d]比较，差异均无统计学意义（均P〉0.05）；MIST组和INSURE组患儿均无死亡、无脑室内出血发生；MIST组与INSURE组气胸（0比4.0%）、支气管肺发育不良（21.7%比16.0%）、早产儿视网膜病（21.7%比12.0%）、坏死性小肠结肠炎（21.7%比2.0%）的发生率比较，差异均无统计学意义（均P〉0.05）。结论对于早产儿NRDS，MIST技术是一种安全有效的PS给药方法。对于临床评估暂不需要进行气管插管机械通气的患儿，均可采用MIST技术予PS。

ObjectiveTo explore the effect and security of minimally invasive surfactant therapy （MIST） in treatment of preterm infants with neonatal respiratory distress syndrome （NRDS）.MethodsA total of 48 pretrm infants with gestational ages between 30-36 weeks diagnosed with NRDS in Guangzhou Women and Children′s Medical Center from January 2017 to January 2018 were randomly divided into MIST group （23 cases） and intubation-surfactant-extubation＋ continuous positive airway pressure ventilation （INSURE） group （25 cases） by adopting random number table method.The patients in MIST group were put on nasal continuous positive airway pressure （nCPAP） and a thin vascular catheter was inserted through the vocal cords under direct vision with direct laryngoscope then infused pulmonary surfactant（PS） into the lung; the patients in INSURE group were endotracheally intubated and infused with PS into the lung through endotracheal tube with positive airway pressure, then extubated and put on nCPAP again.The incidences of adverse reactions and various complications related to the 2 groups were observed.ResultsThere were no significant differences between 2 groups in oxygen saturation decrease（26.1% vs.36.0%）, bradycardia （13.0% vs.24.0%） and reuse PS （8.7% vs.4.0%） （all P〉0.05）. There were no significant differences between 2 groups in noninvasive ventilation time [8 d （5.5-12.5 d） vs.7 d（5.0-14.0 d）], total oxygen intake time [12 d（7.0-26.5 d） vs.10 d（10.0-23.0 d）] and length of hospital stay [（34.22±16.06） d vs.（30.88±14.35） d] （all P〉0.05）. There was no death or intraventricular hemorrhage in both groups, and there were no significant differences between 2 groups in the incidences of pneumothorax （0 vs.4.0%）, bronchopulmonary dysplasia （21.7% vs.16.0%）, retinopathy of prematurity （21.7% vs.12.0%） and necrotizing enterocolitis （21.7% vs.12.0%） （all P〉0.05）.ConclusionsMIST technique is a safe and effective method to administrate surfactant in preterm infants with NRDS.In the NRDS patients who do not need intubation and mechanical ventilation, MIST technique can be used to administrate PS.