LISA技术与气管插管内PS治疗NRDS对早产儿神经系统影响的临床研究

Effects of LISA technology and endotracheal intubation with PS therapy on nervous system of premature infants with NRDS

目的 分析微创表面活性物质运用(LISA)技术与气管插管肺表面活性物质(PS)治疗呼吸窘迫综合征(NRDS)对早产儿神经系统的影响。方法 选取2021年9月至2022年12月在开封市儿童医院入住新生儿重症监护室(NICU)的早产儿80例为研究对象,将其采用随机数表法分为两组,各40例,对照组给予气管插管内PS治疗,观察组给予LISA技术PS治疗。比较两组的二维颅脑超声检查结果、脑血流动力学指标水平、颅脑MRI检查各向异性分数(FA)值、神经发育评估指标异常率。结果 治疗后观察组的脑横径、额叶厚度高于对照组,脑室旁白质回声增强发生率低于对照组,治疗后观察组的收缩期峰值流速(PSV)、舒张末期流速(EDV)、平均流速(MFV)水平高于对照组,阻力指数(RI)及搏动指数(PI)水平低于对照组,治疗后观察组的胼胝体压部、胼胝体膝部、内囊后肢、丘脑、尾状核、枕叶的FA值水平高于对照组,观察组校正胎龄40周的新生儿振幅整合脑电图(aEEG)异常率低于对照组(P<0.05)。结论 LISA技术PS治疗较气管插管内PS治疗能够改善脑血流速度,改善脑神经组织微结构变化,防治脑损伤,保护神经功能。

【Objective】To analyze the effects of less invasive surfactant application(LISA)technology and tracheal intubation of pulmonary surfactant(PS)in the treatment of neonatal respiratory distress syndrome(NRDS)on the nervous system of premature infants.【Methods】Eighty premature infants admitted to the neonatal intensive care unit(NICU)at Kaifeng Children's Hospital from September 2021 to December 2022 were selected as the study subjects.They were randomly divided into two groups using a random number table method,with 40 cases in each group.The control group received endotracheal intubation PS treatment,while the observation group received LISA PS treatment.The results of two-dimensional cranial ultrasound examination,levels of cerebral hemodynamic indicators,fractional anisotropy(FA)values of cranial MRI examination,and abnormal rates of neurological development evaluation indicators were compared between the two groups.【Results】After treatment,the transverse diameter and frontal lobe thickness of the brain in the observation group were higher than those in the control group,the incidence of paraventricular white matter echo enhancement was lower than that in the control group,the levels of peak systolic velocity(PSV),end diastolic velocity(EDV),mean flow velocity(MFV)in the observation group were higher than those in the control group,and the levels of resistance index(RI)and pulsatility index(PI)were lower than those in the control group.After treatment,the FA levels of splenium of corpus callosum,genu of corpus callosum,posterior limb of internal capsule,thalamus,caudate nucleus and occipital lobe were higher than those of the control group,and the abnormal rate of amplitude integrated electroencephalogram(aEEG)corrected for 40 weeks of gestation in the observation group was lower than that in the control group,the difference was significant(P<0.05).【Conclusion】LISA technology PS treatment can improve cerebral blood flow velocity,improve microstructure changes of brain nerve tissue,prevent and treat brain injury,and protect neural function compared with tracheal intubation PS treatment.