雾化肺表面活性物质与微创表面活性物质治疗新生儿呼吸窘迫综合征的比较

Aerosolized surfactant versus minimally invasive surfactant therapy in preterm infants with respiratory distress syndrome

比较在无创辅助通气基础上,雾化肺表面活性物质(aerosolized surfactant,AS)及微创表面活性物质(minimally invasive surfactant therapy,MIST)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床效果。方法回顾性分析在新生儿重症监护病房(neonatal intensive care unit,NICU)住院治疗的22例接受AS治疗以及26例接受MIST的RDS早产患儿临床资料。分析比较两组患儿初始治疗失败率、病死率及各种不良反应发生的情况。结果AS组及MIST组初始治疗失败率、支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率、病死率、总通气时间、无创通气时间、住院时间、以及新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、颅内出血(intraventricular hemorrhage,IVH)、消化道穿孔、气胸/气漏等不良反应发生率均差异无统计学意义(P>0.05)。结论作为RDS早产儿的肺表面活性物质(pulmonary surfactant,PS)给药方式,在本研究中AS治疗临床效果与MIST相当,各种不良反应发生率同MIST比较无差异,可作为一种新的PS给药方式在临床使用,但仍需进一步进行大样本研究。

Objective To compare the efficacy and safety of aerosolized surfactant(AS) with minimally invasive surfactant therapy(MIST) on the treatment of very low birth weight(VLBW) infants with respiratory distress syndrome(RDS). Methods In total, 48 VLBW infants who were born before 30 gestational weeks with spontaneous breathing, respiratory distress, and requiring surfactant therapy were enrolled. The infants in Group AS(n=22) received surfactant via vibrating perforated membrane nebulizer and the infants in Group MIST(n=26) received tracheal instillation of surfactant via a semirigid tracheal suction catheter during spontaneous breathing under nasal intermittent positive pressure ventilation(NIPPV). After surfactant instillation, all of the infants were still placed on NIPPV. Results Our data showed that infants in Group AS had slightly lower rate of bronchopulmonary dysplasia(BPD) and duration of oxygen, but still without statistically difference. And the incidence of intubation within 3 days, death and other side effects were not statistically different between the two groups. Conclusion AS is feasible, safe and it may reduce the BPD for VLBW infants with RDS requiring surfactant replacement therapy.