LISA与INSURE对NRDS早产患儿脑氧代谢、氧合及临床预后的影响

Effects of LISA and INSURE on cerebral oxygen metabolism,oxygenation and clinical prognosis in preterm infants with respiratory distress syndrome

目的探究低侵入性肺表面活性物质给药(LISA)与气管插管-注入肺表面活性物质-拔管(INSURE)对新生儿呼吸窘迫综合征(NRDS)早产儿患脑氧代谢、氧合及临床预后的影响。方法选择2020年1月—2021年12月本院新生儿科收治的124例NRDS早产患儿,分为对照组60例和观察组64例。对照组患儿常规给予INSURE技术治疗,观察组患儿给予LISA技术治疗,分析两组患儿治疗情况、脑氧代谢、全身氧代谢及临床预后。结果观察组患儿插管用时、无创呼吸支持时间短于对照组,72 h内机械通气率低于对照组,差异有统计学意义(P<0.05),而肺表面活性物质二次给药率与对照组比较差异无统计学意义(P>0.05);随着时间推移,两组患儿脑氧饱和度(ScO_(2))水平均先升后降,但观察组用药期间、用药后5 min的ScO_(2)水平低于对照组,差异均有统计学意义(P<0.05);两组患儿治疗前、治疗24 h后的血pH值比较差异均无统计学意义(P>0.05),治疗24 h后的血氧分压(PaO_(2))、氧合指数较治疗前提高,血二氧化碳分压(PaCO_(2))水平降低,且均以观察组更明显,差异均有统计学意义(P<0.05);观察组患儿心动过缓、插管所致损伤的不良反应发生率和颅内出血、支气管肺发育不良的并发症发生率低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05),两组死亡率和其余不良反应、并发症发生率比较差异无统计学意义(P>0.05)。结论相比于INSURE技术,LISA技术治疗对NRDS早产儿脑氧代谢、氧合状况影响更小,更有利于减少患儿机械通气率、不良反应和并发症发生率,改善患儿临床预后。

Objective To explore the effects of less-invasive surfactant administration(LISA)and intubation-surfactant-extubation(INSURE)on cerebral oxygen metabolism,oxygenation and clinical prognosis in preterm infants with respiratory distress syndrome.Methods 124 preterm infants with neonatal respiratory distress syndrome(NRDS)admitted to the hospital from January 2020 to December 2021 were selected and randomly divided into 60 cases in control group and 64 cases in observation group.The children in the control group were routinely given INSURE treatment,and the children in the observation group were treated with LISA.The treatment status,cerebral oxygen metabolism,systemic oxygen metabolism and clinical prognosis were analyzed in the two groups of children.Results The intubation duration and non-invasive respiratory support duration of children in observation group were shorter than those in control group(P<0.05),and the mechanical ventilation rate within 72 h was lower than that in control group(P<0.05),but there was no statistical significance in the secondary administration rate of pulmonary surfactant compared to control group(P>0.05).As time went by,the cerebral oxygen saturation(ScO_(2))level of the two groups of children was increased first and then decreased,but the level of ScO_(2)during medication and at 5 min after medication was lower in observation group than that in control group(P<0.05).There was no statistical difference in blood pH value between the two groups of children before treatment and after 24 h of treatment(P>0.05),and the partial pressure of blood oxygen(PaO_(2))and oxygenation index after 24 h of treatment were enhanced compared with those before treatment(P<0.05)while the partial pressure of blood carbon dioxide(PaCO_(2))was reduced(P<0.05),and the changes were more obvious in observation group(P<0.05).The incidence rates of adverse reactions such as bradycardia and intubation-induced injury and the incidence rates of complications of intracranial hemorrhage and bronchopulmonary dysplasia in observation group were lower compared with those in control group,and the hospital stay was shorter than that in control group(P<0.05),and the differences in the mortality rate and incidence rates of other adverse reactions and complications were not statistically significant between the two groups(P>0.05).Conclusion Compared with INSURE,LISA has smaller effects on cerebral oxygen metabolism and oxygenation in preterm infants with NRDS,and the latter one is more conducive to reducing the mechanical ventilation rate and incidence rates of adverse reactions and complications and improving the clinical prognosis of children.