经麻醉导管微创注入肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效

Clinical effect of pulmonary surfactant injection through anesthesia catheter in treatment of neonatal respiratory distress syndrome

目的 分析经麻醉导管微创注入肺表面活性物质(PS)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法 选取2015年1月—2018年12月新余市人民医院NICU收治的48例NRDS患儿,采用随机数字表分为麻醉导管微创注入PS组(MIST组,25例)和传统气管插管注入PS组(INSURE组,23例)。INSURE组采用传统气管插管注入PS,给药完成后拔除气管插管并采用鼻塞持续气道正压通气(nCPAP)治疗。MIST组采用硬膜外麻醉导管气管插管注入PS,给药过程中始终保持nCPAP治疗。比较两组患儿脉搏血氧饱和度(SpO_(2)),心率,再次使用PS率,72 h内机械通气率,病死率,支气管肺发育不良(BPD)、感染性肺炎、气漏综合征、坏死性小肠结肠炎(NEC)及颅内出血(ICH)发生情况。结果 与治疗前比较,MIST组患儿治疗后1 h、24 h、72 h的动脉/肺泡氧分压比值(a/APO_(2))、动脉血氧分压/吸入氧气浓度(PaO_(2)/FiO_(2))比值均显著升高(F=-4.187,P<0.01;F=-3.719,P<0.01),INSURE组患儿治疗后1 h、24 h、72 h的a/APO_(2)、PaO_(2)/FiO_(2)比值均显著升高(F=-6.972,P<0.01;F=-6.671,P<0.01)。MIST组感染性肺炎发生率(12.00%)显著低于NSURE组(39.13%),差异有统计学意义(χ^(2)=4.703,P<0.05)。结论 经麻醉导管微创注入PS治疗NRDS安全、有效,可避免传统气管插管的缺点,具有损伤小、操作简单及并发症少等优点。

Objective To analyze the clinical effect of pulmonary surfactant(PS) injection through anesthesia catheter in treatment of neonatal respiratory distress syndrome(NRDS).Methods From January 2015 to December 2018, 48 neonates with NRDS treated in Xinyu People’s Hospital were selected and divided into PS injection through anesthesia catheter group(MIST group, 25 cases) and PS injection through traditional tracheal intubation group(INSURE group, 23 cases) according to random number table. The neonates in INSURE group were treated with PS injection through traditional tracheal intubation, tracheal intubation was removed after injection, then nasal continuous positive airway pressure(nCPAP) was used;the neonates in MIST group were treated with PS injection through anesthesia catheter and continuous nCPAP.The levels of pulse oxygen saturation(SpO_(2)), heart rate, PS usage rate for the second time, mechanical ventilation rate within 72 hours, fatality rate, incidence rates of bronchopulmonary dysplasia(BPD), infectious pneumonia, air leak syndrome, necrotizing enterocolitis(NEC), and intracranial hemorrhage in the two groups were compared.Results Compared with before treatment, the ratios of arterial/alveolar oxygen partial pressure ratio(a/APO_(2)), arterial partial pressure of oxygen/inhaled oxygen concentration(PaO_(2)/FiO_(2)) at 1, 24, and 72 hours after treatment in MIST group increased significantly(F=-4.187, P<0.01;F=-3.719, P<0.01), the ratios of a/APO_(2)and PaO_(2)/FiO_(2)at 1, 24, and 72 hours after treatment in INSURE group increased significantly(F=-6.972, P<0.01;F=-6.671, P<0.01).The incidence rate of infectious pneumonia in MIST was 12.00%, which was statistically significantly lower than that in NSURE group(39.13%)(χ^(2)=4.703,P<0.05).Conclusion PS injection through anesthesia catheter is safe and effective in treatment of NRDS, the method can avoid the disadvantages of traditional tracheal intubation, which has the advantages of less injury, simple operation, and less complications.