微创肺表面活性物质应用在早产儿呼吸窘迫综合征中的临床研究

Clinical study of less invasive surfactant administration in preterm infants with neonatal respiratory distress syndrome

目的评价微创肺表面活性物质(PS)应用在早产儿呼吸窘迫综合征(NRDS)中的有效性。方法选取2019年5月至2021年5月甘肃省妇幼保健院新生儿重症监护中心胎龄<32周的105例NRDS早产儿进行前瞻性随机对照研究,使用随机数字表法分为微创组(50例)和对照组(55例),微创组运用微创肺表面活性物质给药(LISA)管在无菌操作下缓慢滴入PS,对照组按照常规给药方法,持续气道正压(CPAP)辅助通气,气管插管后PS注入。比较两组患儿给药过程中的不良反应、2次使用PS情况、生后72小时机械通气及呼吸支持时间、矫正36周病死率及并发症发生率。结果两组患儿在给药过程中均没有肺出血和心率减慢发生,在2次使用PS、生后72小时机械通气使用情况、机械通气使用时间方面差异无统计学意义(P>0.05);微创组呼吸支持时间短于对照组,差异有统计学意义(Z=-2.288,P<0.05);两组在治疗过程中均未出现矫正胎龄36周死亡,微创组患儿有血流动力学影响的动脉导管未闭(hsPDA)发生率低于对照组,差异有统计学意义(χ2=4.471,P<0.05),其余并发症差异无统计学意义(P>0.05)。结论微创肺表面活性物质应用在有自主呼吸的NRDS患儿中是安全可行的,并可以减少呼吸支持的时间、降低hsPDA的发生率,但其有效性仍需进一步验证。

Objective To explore the efficacy of less invasive pulmonary surfactant(PS)in preterm infants with neonatal respiratory distress syndrome(NRDS).Methods A prospective randomized controlled study was conducted in 105 premature infants with NRDS whose gestational age was less than 32 weeks in neonatal intensive care unit of Gansu Provincial Maternity and Child-care Hospital from May 2019 to May 2021.Infants were divided into the less invasive surfactant administration(LISA)group(50 cases)and the control group(55 cases)by randomized number table method.In the LISA group,PS was slowly dripped into the LISA tube under aseptic procedure.The control group was treated with regular intubation combined with continuous positive airway pressure(CPAP)assisted ventilation,and PS injection after endotracheal intubation.Adverse reactions during drug administration,two times of PS use,time of mechanical ventilation and respiratory support 72 hours after birth,mortality at 36 weeks of adjusted gestational age,and complication rate were compared between the two groups.Results There was no pulmonary hemorrhage or bradycardic in the two groups during administration,and there was no significant difference in the use of PS twice,mechanical ventilation 72 hours after birth,and mechanical ventilation(P>0.05).The respiratory support time of the LISA group was shorter than that of the control group,and the difference was statistically significant(Z=-2.288,P<0.05).There was no death in both groups at 36 weeks of adjusted gestational age.The incidence of hemodynamically significant patent ductus arteriosus(hsPDA)were lower in the LISA group than that in the control group(x=4.471,P=0.034),while there was no significant difference in other complications in both two groups(P>0.05).Conclusion The LISA technique is safe and feasible in children with spontaneous breathing and NRDS,and can reduce the time of respiratory support and the incidence of hsPDA,but its effectiveness stil needs to be further verified.