微创肺表面活性物质给药技术对早产儿呼吸窘迫综合征临床疗效的分析

Clinical Efficacy of Minimally Invasive Pulmonary Surfactant Delivery Technique on Respiratory Distress Syndrome in Premature Infants

目的:探讨微创肺表面活性物质(pulmonary surfactant,PS)给药技术对早产儿呼吸窘迫综合征的临床疗效、并发症、神经预后情况。方法:选取2018年8月—2019年7月出生后即在广州医科大学附属第三医院新生儿重症监护室(neonatal intensive care unit,NICU)住院治疗的新生儿92例,根据PS给药方式分为气管插管组和微创组;比较2组患儿治疗过程中的临床疗效、并发症发生情况、纠正胎龄35周时神经发育评估结果的差异。结果:微创组患儿72 h内有创通气率低于气管插管组(2.27%vs 14.03%,P=0.0396,),微创组轻度颅内出血发生率低于气管插管组(16.28%vs 36.73%,P<0.05);2组患儿的临床疗效指标(如住院期间再次使用PS、无创气道正压通气时长、总用氧时长等)和在操作过程中发生不良事件(如心动过缓、血氧饱和度下降等)经比较其差异无统计学意义(P>0.05),2组患儿发生支气管肺发育不良、早产儿视网膜病变、有血流动力学意义的动脉导管未闭等早产儿常见并发症及住院期间神经行为评分<35分的比例经比较其差异无统计学意义(P>0.05)。结论:与传统给药方式相比,微创肺表面活性物质给药技术能降低早产儿72 h内机械通气率及住院期间轻度颅内出血发生率,且对短期临床疗效、早产儿常见并发症及短期神经结局等无明显影响。

Objective:To investigate the clinical efficacy,complications and neurological prognosis of pulmonary surfactant(PS)in the treatment of respiratory distress syndrome in premature infants.Methods:92 neonates hospitalized in the NICU(Neonatal intensive Care Unit)of the Third Affiliated Hospital of Guangzhou Medical University from August 2018 to July 2019 were selected and divided into endotracheal intubation group and minimally invasive group based on PS administration method.The differences in clinical efficacy,complications and neurodevelopmental assessment results at 35 weeks of gestational age were compared between the two groups.Results:The rate of invasive ventilation at 72 h in the minimally invasive group was lower than that in the endotracheal intubation group(2.27%vs14.03%,P=0.0396,),and the incidence of mild intracranial hemorrhage in the minimally invasive group was lower than that in the endotracheal intubation group(16.28%vs 36.73%,P<0.05).There were no statistically significant differences in adverse events such as bradycardia and decreased blood oxygen saturation between the two groups,as well as in clinical efficacy indicators such as re-use of PS during hospitalization,duration of non-invasive positive airway pressure ventilation and total duration of oxygen use(P>0.05).There was no significant difference between the two groups in the proportion of common premature complications such as bronchopulmonary dysplasia,retinopathy of prematurity,patent ductus arteriosus with hemodynamic significance and neurobehavioral score<35 points during hospitalization(P>0.05).Conclusions:Compared with traditional administration,minimally invasive pulmonary surfactant administration could reduce the rate of mechanical ventilation within 72 h and the incidence of mild intracranial hemorrhage during hospitalization of premature infants,and has no significant effect on short-term clinical efficacy,common complications of premature infants and short-term neurological outcomes.