INSURE技术联合布地奈德治疗极低出生体重儿呼吸窘迫综合征对支气管肺发育不良发生率的影响

Effect of INSURE strategy in combination with budesonide on the incidence of bronchopulmonary dysplasia during the treatment of respiratory distress syndrome in very low birth weight

目的分析INSURE技术联合布地奈德治疗极低出生体重儿呼吸窘迫综合征(RDS)对支气管肺发育不良(BPD)发生率的影响,为降低BPD发生率的临床治疗提供科学依据。方法 1)选取于2014年1月—2018年12月出生后1 h内北京大学第三医院NICU收治的胎龄<32周、出生体重1 000~1 500 g、诊断为RDS的患儿83例,分为改良组35例(INSURE技术联合布地奈德,即气管插管-注入肺表面活性物质联合布地奈德-拔管后经鼻持续正压通气)和常规组48例(气管内滴入肺表面活性物质后连接有创机械通气):2、设计临床调查表,记录一般资料、BPD及其他合并症发生率、转归等。结果 1、改良组给药后6 h PO2高于常规组,呼吸机和总用氧时间均较常规组短,差异有统计学意义(t=2.571、3.633、3.484,P<0.05);2、改良组BPD、动脉导管未闭发生率均低于常规组,差异有统计学意义(χ2=3.886、3.920,P<0.05),其他合并症发生率和存活率差异均无统计学意义(P>0.05)。结论 INSURE技术联合布地奈德早期可明显改善氧合指数,缩短呼吸机和总用氧时间,有效降低极低出生体重儿BPD的发生率,同时也明显降低动脉导管未闭的发生率,短期内未增加其他疾病及死亡的风险,值得临床进一步研究及推广。

Objective To analyze the effect of INSURE strategy in combination with budesonide on the incidence of bronchopulmonary dysplasia(BPD) during the treatment of respiratory distress syndrome in very low birth weight,in order to provide scientific basis for clinical treatment to reduce the incidence of BPD. Methods 1、 A total of 83 neonates diagnosed with RDS admitted to Peking University Third Hospital within 1 h after birth from January 2014 to December 2018,whose gestational age was less than 32 weeks and birth weight was from 1 000 to 1 500 g,were selected in this study,and were divided into the modified group with 35 cases(intubation-surfactant and budesonide-extubation) and conventional group with 48 cases(intratracheal administration of surfactant and mechanical ventilation).2、 A clinical questionnaire was designed to collect general information,incidences of BPD and other complications,outcomes and so on. Results 1、 PO2 in the modified group was higher than that in the conventional group at 6 h after administration,and both ventilator and total oxygen use time were significantly shorter than those in the conventional group(t=2.571,3.633,3.484,P<0.05).2、 The incidence of BPD and patent ductus arteriosus in the modified group was significantly lower than those in the conventional group(χ2=3.886,3.920,P<0.05).But there were no statistically significant differences on the incidence of other complications and survival rate between the two groups(P>0.05). Conclusions INSURE strategy in combination with budesonide can improve oxygenation in early stage,shorten ventilator and total oxygen use time,significantly reduce the incidence of BPD,and also reduce the incidence of patent ductus arteriosus,which does not increase the risk of other diseases and death in the short term.Therefore,further researches are warranted so as to promote its application on clinical practice.