LISA与INSURE对呼吸窘迫综合征早产儿脑血流动力学的影响

Effect of LISA Versus INSURE on Cerebral Hemodynamics in Preterm Infants:a Randomized Controlled Trial

目的比较微创表面活性物质给药技术(LISA)与气管插管-肺表面活性物质-拔管-持续正压通气(INSURE)对呼吸窘迫综合征早产儿脑血流动力学的影响。方法前瞻性纳入2019年6月到2021年3月遂宁市中心医院收治的出生后6 h内且需要使用肺泡表面活性物质(PS)的84例早产儿,随机分配为LISA组(42例)和INSURE组(42例),观察患儿结局。主要结局指标包括给药前0~5 min,给药后5~10 min,给药后15~20 min、给药后25~30 min超声多普勒测定的脑血流动力学参数:收缩期峰值流速(PSV)、舒张期峰值流速(EDV)和阻力指数(RI);次要结局包括氧饱和度下降率、心动过缓率、重复使用肺表面活性物质率、72 h内机械通气率、支气管肺发育不良(BPD)发生率、72 h内颅内出血率。结果LISA组和INSURE组实际纳入统计分析的早产儿均是42例。患儿各时间点PSV、EDV、RI在LISA组和INSURE组间差异无统计学意义(P>0.05)。两组患儿的氧饱和度下降率、心动过缓率、重复使用肺表面活性物质率、72 h内机械通气率、BPD发生率、72 h内颅内出血率比较,差异无统计学意义(P>0.05)。结论LISA与INSURE技术应用PS对早产儿脑血流动力学的影响无明显不同。

Objective To compare the effects of LISA and INSURE on cerebral hemodynamics in preterm infants who diagnosed with neonatal respiratory distress syndrome(NRDS).Methods A total of 84 preterm infants(within 6 hours after birth)who needed to use pulmonary surfanctant(PS)in Suining Central Hospital from June 2019 to March 2021 were enrolled and randomly divided into LISA group(42 cases)and INSURE group(42 cases).The primary outcome indexes included cerebral hemodynamic parameters[peak systolic flow velocity(PSV),end diastolic velocity(EDV),and resistance index(RI)]measured by ultrasound before0~5 minutes and 5~10 minutes,15~20 minutes,25~30 minutes after surfactant administration in two groups.Secondary outcome indexes included the incidence of transcutaneous oxygen saturation(TcS O2)reduction,bradycardia,repeated PS administration,the mechanical ventilation within 72 hours after birth,bronchopulmonary dysplasia(BPD),intraventricular hemorrhage within 72 hours after birth.Results A total of 42 patients in each group were finally picked up for statistical analysis.There was no significant difference in PSV,EDV and RI between the two groups at all time points during surfanctant administration(P>0.05).There was also no significant difference between the two groups in the incidence rate of transcutaneous oxygen saturation(TcS O2)reduction,bradycardia,repeated PS administration,the mechanical ventilation within 72 hours after birth,bronchopulmonary dysplasia(BPD),and intraventricular hemorrhage within 72 hours.Conclusion The technology LISA and INSURE has similar effect on cerebral hemodynamics in the effect of PS.