微创肺表面活性物质注入技术联合双水平气道正压通气治疗早产儿呼吸窘迫综合征

Less invasive surfactant administration combined with bi-level positive airway pressure in preterm infants with respiratory distress syndrome:a clinical research

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.