经LISA导管注入肺泡表面活性物质治疗新生儿呼吸窘迫综合征的效果与安全性

Effect and safety of injecting pulmonary surfactant through LISA catheter in the treatment of neonatal respiratory distress syndrome

目的探讨经国产专用微创注入肺表面活性物质(LISA)导管注入肺泡表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的效果与安全性。方法选择2019年1月至2020年12月本院新生儿重症监护室收治的71例NRDS早产儿为研究对象,采用随机数字表法将其分为对照组(n=36)和观察组(n=35)。对照组采用传统气管插管-注入PS-拔管后经鼻持续气道正压通气(INSURE)技术,观察组采用LISA技术,即在持续无创通气下经国产专用LISA导管注入PS。比较两组的操作相关指标(置管失败、置管时间、给药时SpO_(2)下降、心动过缓、重复使用PS、72 h内改机械通气、无创辅助通气时间、总氧疗时间)。比较两组的并发症(喉头损伤、气漏综合征、肺出血、消化道出血、应激性高血糖、代谢性酸中毒、hs-PDA、败血症、BPD、IVH/PVL、NEC)发生情况。结果观察组的置管失败率显著低于对照组,差异具有统计学意义(P<0.05)。观察组的置管时间显著短于对照组,差异具有统计学意义(P<0.05)。两组的给药时SpO_(2)下降、心动过缓、重复使用PS及72 h内改机械通气占比比较,差异无统计学意义(P>0.05)。观察组的无创辅助通气时间与总氧疗时间短于对照组,差异具有统计学意义(P<0.05)。观察组的喉头损伤、气漏综合征及BPD发生率显著低于对照组,差异具有统计学意义(P<0.05)。两组的肺出血、消化道出血、应激性高血糖、代谢性酸中毒、hs-PDA、败血症、IVH/PVL及NEC发生率比较,差异无统计学意义(P>0.05)。结论与INSURE技术相比,使用国产专用LISA导管的LISA技术操作简单、安全,可降低置管失败率,缩短置管时间、无创辅助通气时间与总氧疗时间,且在减少喉头损伤、气漏综合征及BPD发生方面有明显优势,是一种安全有效的给药方式。

Objective To explore the effect and safety of injecting pulmonary surfactant(PS)through domestic special less invasive surfactant administration(LISA)catheter in the treatment of neonatal respiratory distress syndrome(NRDS).Methods Seventy-one premature infants with NRDS treated in the neonatal intensive care unit of our hospital from January 2019 to December 2020 were selected as the research objects and divided into control group(n=36)and observation group(n=35)according to random number table method.The control group was treated with traditional intubate-surfactant-extubate(INSERT)technology,and the observation group was treated with LISA technology,namely,PS was injected through domestic special LISA catheter under continuous noninvasive ventilation.The operation related indexes(catheterization failure,catheterization time,SpO_(2) decrease during administration,bradycardia,repeated use of PS,change to mechanical ventilation within 72 h,noninvasive auxiliary ventilation time and total oxygen therapy time)were compared between the two groups.The occurrences of complications(laryngeal injury,air leak syndrome,pulmonary hemorrhage,gastrointestinal bleeding,stress hyperglycemia,metabolic acidosis,hs-PDA,sepsis,BPD,IVH/PVL,NEC)were compared between the two groups.Results The rate of catheterization failure in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The catheterization time of the observation group was significantly shorter than that of the control group,and the difference was statistically significant(P<0.05).There were no significant differences in the proportions of SpO_(2) decrease during administration,bradycardia,repeated use of PS and change to mechanical ventilation within 72 h between the two groups(P>0.05).The noninvasive auxiliary ventilation time and total oxygen therapy time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The incidences of laryngeal injury,air leak syndrome and BPD in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).There were no significant differences in the incidences of pulmonary hemorrhage,gastrointestinal bleeding,stress hyperglycemia,metabolic acidosis,hs-PDA,sepsis,IVH/PVL and NEC between the two groups(P>0.05).Conclusion Compared with INSERT technology,LISA technology using domestic special LISA catheter is simple and safe.It can reduce the rate of catheterization failure,shorten the catheterization time,noninvasive auxiliary ventilation time and total oxygen therapy time,and has obvious advantages in reducing laryngeal injury,air leak syndrome and BPD,which is a safe and effective way of administration.