摘要
目的探讨微创肺表面活性物质注入(less invasive surfactant administration, LISA)技术联合双水平气道正压通气(bi-level positive airway pressure, BiPAP)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome, RDS)的临床疗效及安全性。方法选择2020年1月至2021年10月徐州市中心医院新生儿重症监护病房收治的胎龄26~32周RDS早产儿进行前瞻性研究, 随机分为LISA+BiPAP组和气管插管-使用肺表面活性物质-拔管(intubation-surfactant-extubation, INSURE)+经鼻持续气道正压通气(nasal continuous positive airway pressure, NCPAP)组, 根据分组给予相应治疗。比较两组气管注入肺表面活性物质后1 h、6 h的血气分析、用药情况、无创呼吸支持时间、总用氧时间、撤机失败率及治疗72 h内气管插管率等临床疗效, 以及支气管肺发育不良(bronchopulmonary dysplasia, BPD)等并发症发生情况。结果共纳入RDS早产儿86例, LISA+BiPAP组44例, INSURE+NCPAP组42例。LISA+BiPAP组气管注入肺表面活性物质后1 h、6 h的动脉血氧分压高于INSURE+NCPAP组, 氧合指数和动脉血二氧化碳分压低于INSURE+NCPAP组, 差异均有统计学意义(P<0.05)。LISA+BiPAP组无创呼吸支持时间[(12.2±8.7)d比(16.0±7.6)d]、总用氧时间[(16.6±8.3)d比(20.3±7.4)d]、住院时间[(22.6±10.3)d比(27.1±12.6)d]、撤机失败率[11.4%(5/44)比 31.0%(13/42)]、治疗72 h内气管插管率[11.4%(5/44)比28.6%(12/42)]及使用2次肺表面活性物质比例[18.2%(8/44)比38.1%(16/42)]均低于INSURE+NCPAP组, 差异有统计学意义(P<0.05)。LISA+BiPAP组插管所用时间和肺表面活性物质反流发生率低于INSURE+NCPAP组, 差异均有统计学意义(P<0.05)。LISA+BiPAP组BPD发生率低于INSURE+NCPAP组[11.4%(5/44)比31.0%(13/42)], 差异有统计学意义(P<0.05), 两组其他并发症发生率差异均无统计学意义(P>0.05)。结论 LISA技术联合BiPAP治疗能有效改善胎龄26~32周RDS早产儿氧合, 在缩短无创呼吸支持时间和降低机械通气率、BPD发生率等方面具有优势。
Objective To study the efficacy and safety of less invasive surfactant administration(LISA)combined with bi-level positive airway pressure(BiPAP)ventilation in premature infants with respiratory distress syndrome(RDS).Methods Premature infants with RDS at gestational age of 26~32 weeks in the NICU of our hospital from January 2020 to October 2021 were enrolled in this randomized controlled trial.They were randomly assigned to the LISA+BiPAP group or the intubation-surfactant-extubation(INSURE)+nasal continuous positive airway pressure(NCPAP)group,and given the corresponding treatment according to the group.The blood gas analysis at 1 h and 6 h after intratracheal instillation of pulmonary surfactant(PS),medication,noninvasive respiratory support time,total oxygen use time,weaning failure rate and endotracheal intubation rate within 72 h after PS administration were compared between the two groups,as well as the incidence of bronchopulmonary dysplasia(BPD).Results A total of 86 preterm infants with RDS were enrolled in the study,including 44 in the LISA+BiPAP group and 42 in the INSURE+NCPAP group.Arterial partial pressure of oxygen in the LISA+BiPAP group at 1 h and 6 h after intratracheal instillation of PS were higher than those in the INSURE+NCPAP group,while PaCO_(2) and oxygenation index(OI)were lower than those in the INSURE+NCPAP group,and the differences were statistically significant(all P<0.05).The duration of noninvasive respiratory support time[(12.2±8.7)d vs.(16.0±7.6)d],total oxygen use time[(16.6±8.3)d vs.(20.3±7.4)d],length of hospitalization[(22.6±10.3)d vs.(27.1±12.6)d],weaning failure rate[11.4%(5/44)vs.31.0%(13/42)],endotracheal intubation rate within 72 h after PS administration[11.4%(5/44)vs.28.6%(12/42)],and re-administration of PS[18.2%(8/44)vs.38.1%(16/42)]in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group,and the differences were statistically significant(P<0.05).The time needed for intubation and the incidence of regurgitation in the LISA+BiPAP group were lower than those in the INSURE+NCPAP group,and the differences were statistically significant(P<0.05).The incidence of BPD in the LISA+BiPAP group was lower than those in the INSURE+NCPAP group[11.4%(5/44)vs.31.0%(13/42)](P<0.05),the difference was also statistically significant(P<0.05).There was no significant difference in the incidence of other complications between the two groups(P>0.05).Conclusions LISA combined with BiPAP can effectively improve oxygenation,reduce the mechanical ventilation rate,shorten the duration of non-invasive respiratory support,and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26~32 weeks.
作者
马秀慧
金宝
雷红林
杨波
苏敏
李丽
Ma Xiuhui;Jin Bao;Lei Honglin;Yang Bo;Su Min;Li Li(Department of Neonatology,Xuzhou Central Hospital(Xuzhou Hospital Affiliated to Southeast University),Xuzhou 221009,China)
基金
徐州市科技局重点研发计划(社会发展KC18188)。