微创肺表面活性物质联合经鼻间歇正压通气治疗早产儿呼吸窘迫综合征临床研究

Clinical Study of Less Invasive Pulmonary Surfactants Combined with Nasal Intermittent Positive Pressure Ventilation in the Treatment of Respiratory Distress Syndrome in Premature Infants

目的:探讨微创肺表面活性物质给药(LISA)联合经鼻间歇正压通气(NIPPV)在治疗早产儿呼吸窘迫综合征(RDS)中的疗效。方法:选择2021年9月至2022年12月深圳市第二人民医院新生儿科和广西河池市人民医院新生儿科收治的28周≤胎龄≤34周的RDS 95例进行前瞻性研究,根据肺表面活性物质(PS)不同给药方法分为气管插管–使用肺表面活性物质–拔管(INSURE)+经鼻持续气道正压通气(NCPAP)组(47例)和LISA+NIPPV组(48例)。INSURE+NCPAP组患儿给予INSURE联合NCPAP治疗,LISA+NIPPV组患儿给予LISA技术联合NIPPV治疗。比较两组患儿不同给药方式给药期间不良反应及近期并发症发生率等情况。结果:LISA+NIPPV组患儿喉头损伤、气漏综合征及PS反流发生率低于INSURE+NCPAP组,差异具有统计学意义(P<0.05);两组患儿给药过程中经皮血氧饱和度下降、心动过缓、再次使用PS发生率比较,差异无统计学意义(P>0.05)。LISA+NIPPV组患儿置管时间、无创通气时间短于INSURE+NCPAP组,差异具有统计学意义(P<0.05);而两组患儿出生后首次使用PS时间、总用氧时间比较,差异无统计学意义(P>0.05)。LISA+NIPPV组患儿支气管肺发育不良(BPD)发生率低于INSURE+NCPAP组,差异具有统计学意义(P<0.05);两组患儿72 h内机械通气、肺出血、消化道出血、脑室内出血(IVH)、新生儿坏死性小肠结肠炎(NEC)及脑室周围白质软化(PVL)发生率比较,差异无统计学意义(P>0.05)。结论:早产儿RDS治疗中,与INSURE联合NCPAP治疗相比,LISA给药技术更易操作,置管时间更短,可减少喉头损伤、气漏综合征及PS反流等不良反应的发生,在BPD的发生及无创通气时间上更有优势,故NIPPV可作为RDS治疗时NCPAP的替代方法。

Objective To investigate the efficacy of less invasive surfactant administration(LISA)combined with nasal intermittent positive pressure ventilation(NIPPV)in the treatment of respiratory distress syndrome(RDS)in premature infants.Methods A prospective study was conducted on 95 premature infants with RDS of 28 weeks≤gestational age≤34 weeks in the neonatal department of Shenzhen Second People's Hospital and Guangxi Hechi People's Hospital from September 2021 to December 2022.According to the different administration methods of pulmonary surfactants(PS),they were divided into intubation-using pulmonary surfactant-extubation(INSURE)+nasal continuous positive airway pressure(NCPAP)group(47 cases)and LISA+NIPPV group(48 cases).The INSURE+NCPAP group patients were treated with INSURE combined with NCPAP,while the LISA+NIPPV group patients were treated with LISA technology combined with NIPPV.The incidence of adverse reactions and recent complications during the administration of different medication methods between two groups of children were compared.Results The incidences of laryngeal injury,air leakage syndrome,and PS reflux in the LISA+NIPPV group were lower than those in the INSURE+NCPAP group,with statistically significant differences(P<0.05).There were no statistically significant differences in the incidence of decreased percutaneous oxygen saturation,bradycardia,and reuse of PS between the two groups of children during the administration process(P>0.05).The intubation time and non-invasive ventilation time of the LISA+NIPPV group were shorter than those of the INSURE+NCPAP group,and the differences were statistically significant(P<0.05).However,there was no statistically significant difference in the first use of PS and total oxygen use time between the two groups of children after birth(P>0.05).The incidence of bronchopulmonary dysplasia(BPD)in the LISA+NIPPV group was lower than that in the INSURE+NCPAP group,and the difference was statistically significant(P<0.05).There were no statistically significant difference between the two groups in terms of mechanical ventilation,pulmonary hemorrhage,gastrointestinal bleeding,intraventricular hemorrhage(IVH),neonatal necrotizing enterocolitis(NEC),and periventricular leukomalacia(PVL)within 72 hours.Conclusion In the treatment of RDS in premature infants,compared with INSURE combined with NCPAP,LISA administration technique is easier to operate and catheterization time is shorter,which can reduce the occurrence of laryngeal injury,air leakage syndrome and PS reflux,and has more advantages in the occurrence of BPD and noninvasive ventilation time.Therefore,NIPPV can be used as an alternative to NCPAP in RDS treatment.