改良LISA技术在新生儿呼吸窘迫综合征中的临床疗效

Clinical efficacy of modified LISA technique in neonatal respiratory distress syndrome

目的探讨改良微创肺表面活性物质给药(LISA)技术治疗新生儿呼吸窘迫综合征(NRDS)的安全性和有效性。方法选取2020年5月至2021年12月深圳市第二人民医院和河池市人民医院出生胎龄≤34周诊断为NRDS的早产儿128例进行前瞻性研究。所有早产儿均使用LISA技术操作,随机分为改良LISA组和LISA组,其中改良LISA组延长给药注入时间至10 min,LISA组常规快速给药,时间为3 min内,两组早产儿给药期间均予以经鼻无创正压通气(NCPAP)无创通气模式呼吸支持治疗。比较两组早产儿给药期间心动过缓、经皮血氧饱和度下降、药物反流率及治疗前后不同时间点动脉血气指标及并发症发生率。结果两组患儿给药过程中心动过缓、血氧饱和度下降、生后72 h机械通气率及治疗前不同时间点血气指标比较,差异无统计学意义(P>0.05);两组早产儿支气管肺发育不良、视网膜病变、坏死性小肠结肠炎、Ⅲ~Ⅳ级颅内出血及气漏综合征等并发症发生率比较,差异无统计学意义(P>0.05);与LISA组相比,改良LISA组给药过程中药物反流率更低(6.35%vs.33.33%),差异有统计学意义(P<0.05)。结论改良LISA技术与LISA技术疗效相当,未增加治疗后并发症的发生,可明显降低PS给药过程中药物反流率,值得在临床中推广。

Objective To explore the safety and efficacy of modified less invasive surfactant administration(LISA)technique in the treatment of neonatal respiratory distress syndrome(NRDS).Methods A total of 128 premature infants born at a gestational age of≤34 weeks and diagnosed as NRDS were selected from the Shenzhen Second People’s Hospital and the People’s Hospital of Hechi from May 2020 to December 2021 for a prospective study.All premature infants were treated with the LISA technique,and were randomly divided into the modified LISA group and the LISA group.The administration time was extended to 10 minutes for the modified LISA group and the conventional rapid administration time was within 3 minutes for the LISA group.Both groups of premature infants were given respiratory support with non-invasive nasal continuous positive airway pressure(NCPAP)ventilation mode during the administration period.The occurrence of bradycardia and decrease of transcutaneous oxygen saturation during administration,drug reflux rate,arterial blood gas index at different time points before and after treatment and the incidence of complications were compared between the two groups.Results There were no statistically significant differences between the two groups in bradycardia and decrease of blood oxygen saturation during administration,blood gas index before treatment and at different time points and 72 h mechanical ventilation rate after birth(P>0.05).There were no statistically significant differences between the two groups of premature infants in the incidence of complications such as bronchopulmonary dysplasia,retinopathy of prematurity,necrotizing enterocolitis,gradeⅢ-Ⅳintraventricular hemorrhage and air leak syndrome(P>0.05).Compared with that in the LISA group,the drug reflux rate in the modified LISA group was lower(6.35%vs.33.33%,),and the difference was statistically significant(P<0.05).Conclusion The modified LISA technique has the same effect as the LISA technique,without increasing the incidence of complications after treatment,and can significantly reduce the incidence of drug reflux during pulmonary surfactant(PS)administration,which is worthy of promotion in clinical practi ce.