微创肺表面活性物质运用技术治疗早产儿呼吸窘迫综合征疗效观察

Observation on the effect of minimally invasive surfactant therapy in the treatment of premature infants with respiratory distress syndrome

目的观察微创肺表面活性物质运用技术在治疗早产儿呼吸窘迫综合征中的疗效。方法选取2018年1月-2019年3月蚌埠医学院第一附属医院新生儿重症监护病房(NICU)住院的RDS早产儿60例作为研究对象,随机数字表法分为采用微创肺表面活性物质运用(MIST)技术的观察组(MIST组,30例)和气管插管-使用PS-拔管(INSURE)使用经鼻持续气道正压通气(NCPAP)技术的对照组(INSURE组,30例),收集和分析相关临床资料,比较氧代谢指标、二次PS应用、气胸、支气管肺发育不良(bronchopulmonary dysplasia,BPD)、死亡发生率及72 h内机械通气比例、住院时间等情况。结果在6、12、24、48 h时,FiO2、PaO2、P/F、PaO2/PAO2指标MIST组明显低于INSURE组,而PEEP/EPAP、PaCO2指标相比,MIST组明显高于INSURE组,MIST组与INSURE组二次PS应用率(3.33%vs. 20.00%)、气胸(0.00%vs.16.67%)、住院时间差异具有统计学意义(均P<0.05)。而MIST组与INSURE组72 h内机械通气(0.00%vs. 3.33%)、BPD率(0.00%vs. 3.33%)比较差异无统计学意义(均P>0.05),2组均无早产儿死亡。结论微创肺表面活性物质运用(MIST)技术治疗早产儿RDS,可明显改善患儿氧代谢指标、减少二次PS应用、气胸比例,缩短患儿住院时间,改善早产儿预后。

Objective To observe the effect of minimally invasive surfactant therapy in the treatment of premature infants with respiratory distress syndrome. Methods Sixty premature infants with RDS hospitalized in the Neonatal Intensive Care Unit(NICU) of the First Affiliated Hospital of Bengbu Medical College from January 2018 to March 2019 were randomly divided into MIST group(30 cases) using minimally invasive pulmonary surfactant application technology and INSURE group(30 cases) using intubation-PS-extubation by nasal positive airway pressure ventilation. The relevant clinical data were collected and analyzed. The oxygen metabolism index, secondary PS application, pneumothorax, bronchopulmonary dysplasia(BPD), mortality rate, the proportion of mechanical ventilation within 72 hours, and hospitalization time were compared. Results At 6, 12, 24 and 48 hours, FiO2, PaO2, P/F, PaO2/PAO2 in MIST group were significantly less than those in INSURE group, while PEEP/EPAP and PaCO2 in MIST group were significantly higher than those in INSURE group. There were significant differences in secondary PS application rate(3.33% vs. 20.00%), pneumothorax(0.00% vs.16.67%) and hospitalization time between two groups(all P<0.05). There were no significant differences in 72 h mechanical ventilation(0.00% vs.3.33%), BPD(0.00% vs.3.33%) between MIST group and INSUR group,there was no death in two groups. Conclusion Minimally invasive pulmonary surfactant therapy can significantly improve oxygen metabolism, reduce secondary PS application and pneumothorax ratio, shorten hospitalization time and improve the prognosis of premature infants with RDS.