LISA技术治疗超早产儿RDS应用观察

Clinical research of LISA technique in the treatment of extremely preterm infants with RDS

目的 探讨微创表面活性物质注射(LISA)技术在超早产儿呼吸窘迫综合征(RDS)中的应用疗效及价值。方法 选取2019年9月~2021年4月潍坊市妇幼保健院及潍坊医学院附属医院NICU收治的超早产RDS患儿进行前瞻性研究,根据入院后肺表面活性物质(PS)应用方式不同,分为LISA组及INSURE组,分别比较两组患儿给药过程不良反应发生率、给药效果、近期并发症发生率以及矫正胎龄36周死亡率。结果 共94例患儿纳入研究,其中LISA组45例,INSURE组49例。LISA组72h机械通气率、住院期间总用氧时间、具有血流动力学影响的动脉导管未闭发生率、支气管肺发育不良发生率均低于INSURE组,差异具有统计学意义(P<0.05);两组患儿PS反流率、心动过缓及经皮血氧饱和度(SpO_(2))下降发生率、重复使用PS、机械通气时间、脑白质软化发生率、早产儿视网膜病≥3期发生率、脑室内出血≥Ⅲ度发生率、肺气漏发生率及矫正胎龄36周死亡率差异无统计学意义(P>0.05)。结论 LISA技术未增加超早产儿肺表面活性物质应用过程中不良反应发生率,且在降低72h机械通气率、总用氧时间及近期并发症方面具有优势,是一种安全有效治疗超早产儿RDS的方法。

Objective To explore the application and treatment efficacy of less invasive surfactant administration(LISA) technique in extremely preterm infants with respiratory distress syndrome(RDS).Methods Children with ultra-preterm RDS admitted to the NICU of Weifang Maternal and Child Health Hospital and the Affiliated Hospital of Weifang Medical University from September 2019 to April 2021 were selected for a prospective study.According to the different ways of pulmonary surfactant(PS) application after admission, they were divided into LISA group and INSURE group.The incidence of side effects during PS administration, the effect of administration, the incidence of recent complications, and the mortality rate at 36 weeks of corrected gestational age in different groups were compared.Results A total of 94 cases were enrolled including 45 in LISA group and 49 in INSURE group.The rates of mechanical ventilation within 72 hours, total oxygen time during hospitalization, incidence of hemodynamically significant patent ductus arteriosus(hsPDA) and bronchopulmonary dysplasia(BPD) were lower in the LISA group than in the INSURE group(P<0.05).No significant differences existed between the two group on the regurgitation after administration, change of percutaneous oxygen partial pressure and the incidence of bradycardia during administration, repeated PS,mechanical ventilation duration, incidence of periventricular leukomalacia(PVL),incidence of retinopathy of prematurity(ROP) stage ≥3,incidence of intraventricular hemorrhage(IVH) ≥III,incidence of pulmonary air leak, and mortality at corrected gestational age of 36 weeks(P>0.05).Conclusion In the treatment of extremely preterm infants with RDS,The LISA technique did not increase the incidence of adverse effects during the application of PS,and it has advantages in reducing the 72 h mechanical ventilation rate, total oxygen time and recent complications, making it a safe and effective treatment for RDS in ultra-premature infants.