雾化肺表面活性物质与微创表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效比较

Comparison of atomized pulmonary surfactant and minimally invasive pulmonary surfactant in the treatment of neonatal respiratory distress syndrome

目的比较雾化肺表面活性物质(PS)与微创PS治疗新生儿呼吸窘迫综合征的临床疗效。方法回顾性选取2020年2月至2022年2月海南省妇女儿童医学中心呼吸窘迫综合征患儿100例,依据PS治疗方法分为雾化组和微创组,各50例。雾化组通过振动筛网雾化器系统注射PS,微创组在喉镜引导下经声门向气管插入一次性使用呼吸道用吸引导管,向气管注入PS。比较两组患儿机械通气参数[吸气峰压、呼气末正压(PEEP)、呼吸频率],血气指标[吸入氧浓度(FiO_(2))、动脉血氧分压(PO_(2))、动脉血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))],肺功能[第1 s用力呼气容积(FEV1)、用力呼气量(FVC)、FEV1/FVC],炎症因子[核因子-κB(NF-κB)、γ干扰素(IFN-γ)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、降钙素原(PCT)]水平,支气管肺发育不良发生情况。使用PS(PS)次数、吸氧时间、无创通气时间、总通气时间、住院时间、临床疗效及并发症发生情况。结果治疗后,两组患儿的吸气峰压、PEEP、FiO_(2)、PaCO_(2)均明显低于治疗前,PaO_(2)、SaO_(2)、FEV1、FEV1/FVC均明显高于治疗前,差异均有统计学意义(P<0.05);但两组患儿治疗后的吸气峰压、PEEP、呼吸频率、FiO_(2)、PO_(2)、SaO_(2)、PaCO_(2)、FEV1、FVC、FEV1/FVC之间的差异均无统计学意义(P>0.05)。治疗后,两组患儿的NF-κB、IFN-γ、CRP、降钙素原水平均明显低于治疗前,IL-10水平均明显高于治疗前,差异均有统计学意义(P<0.05);但两组患儿治疗后的NF-κB、IFN-γ、IL-10、CRP、PCT水平比较,差异均无统计学意义(P>0.05)。雾化组患儿的支气管肺发育不良发生率为40.00%,明显低于微创组(64.00%),差异有统计学意义(P<0.05)。雾化组患儿的吸氧时间、住院时间分别为(45.02±7.12)、(63.02±9.45)d,明显短于微创组[(56.02±9.25)、(74.02±9.25)d],差异均有统计学意义(P<0.05);但两组患儿的使用PS次数、无创通气时间、总通气时间之间的差异均无统计学意义(P>0.05)。两组患儿的总有效率比较,差异无统计学意义(P>0.05)。两组患儿的并发症发生率之间比较,差异无统计学意义(P>0.05)。结论雾化PS与微创PS治疗新生儿呼吸窘迫综合征的临床疗效相当,但雾化PS更能减少患儿的支气管肺发育不良的发生,缩短患儿的吸氧时间和住院时间。

Objective To compare the clinical efficacy between atomized pulmonary surfactant(PS)and minimally invasive PS in the treatment of neonatal respiratory distress syndrome.Methods A total of 100 cases of neonatal children with respiratory distress syndrome in Hainan Women and Children Medical Center from February 2020 to February 2022 were retrospectively selected and divided into atomized pulmonary surfactant group and minimally invasive pulmonary surfactant group,with 50 cases each.The atomization group was injected with PS through a vibrating screen atomizer system,while the minimally invasive group was guided by a laryngoscope to insert a disposable respiratory suction catheter into the trachea through the glottis,and PS was injected into the trachea.Mechanical ventilation parameters[peak inspiratory pressure,positive end expiratory pressure(PEEP),respiratory frequency],blood gas indicators[inhalation oxygen concentration(FiO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial saturation of oxygen(SaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],lung function[forced expiratory volume(FEV1),forced expiratory volume(FVC),FEV1/FVC],the levels of inflammatory factors[nuclear factor-κB(NF-κB),interferon-γ(IFN-γ),interleukin-10(IL-10),C-reactive protein(CRP),procalcitonin(PCT)],incidence of bronchopulmonary dysplasia,PS use times,oxygen uptake time,non-invasive ventilation time,total ventilation time,hospital stay,clinical efficacy,and incidence of complications in the two groups were compared.Results After treatment,the peak inspiratory pressure,PEEP,FiO_(2),PaCO_(2)of the two groups of children were significantly lower than before treatment,while PaO_(2),SaO_(2),FEV1,FEV1/FVC were significantly higher than before treatment,the differences were statistically significant(P<0.05);however,there were no statistically significant differences in peak inspiratory pressure,PEEP,respiratory rate,FiO_(2),PaO_(2),SaO_(2),PaCO_(2),FEV1,FVC,FEV1/FVC between the two groups of children after treatment(P>0.05).After treatment,the average levels of NF-κB,IFN-γ,CRP,and calcitonin in the two groups of children were significantly lower than before treatment,and the levels of IL-10 were significantly higher than before treatment,the differences were statistically significant(P<0.05);however,there were no statistically significant differences in the levels of NF-κB,IFN-γ,IL-10,CRP,and PCT between the two groups of children after treatment(P>0.05).The incidence of bronchopulmonary dysplasia in the atomized group was 40.00%,which was lower than that in the minimally invasive group(64.00%),the difference was statistically significant(P<0.05).The oxygen inhalation time and the hospital stay of children in the atomization group were(45.02±7.12)and(63.02±9.45)d,respectively,which were significantly shorter than those of the minimally invasive group[(56.02±9.25)and(74.02±9.25)d],the differences were statistically significant(P<0.05),but there were no significantly significant differences between the two groups in PS use times,non-invasive ventilation time and total ventilation time(P>0.05).There was no statistically significant difference in the total effective rate between the two groups of children(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups of children(P>0.05).Conclusion The clinical efficacy of nebulized PS and minimally invasive PS in the treatment of neonatal respiratory distress syndrome is comparable.However,aerosolizing PS can more effectively reduce the occurrence of bronchopulmonary dysplasia in children,shorten their oxygen intake time and hospital stay.