两种不同技术PS给药对NRDS并呼吸困难早产儿肺功能及不良反应的影响

Influence of two different techniques of pulmonary surfactant administration for treating premature infants with distress syndrome and dyspnea on their pulmonary function and adverse reactions

目的:对比不同技术肺表面活性物质(PS)给药联合咖啡因对新生儿呼吸窘迫综合征(NRDS)早产儿肺功能及不良反应的影响。方法:选取2019年8月-2023年8月本院收治的NRDS早产儿,随机数字表以简单随机法分为对照组(n=52)与观察组(n=53),对照组予以气管插管-使用肺表面活性物质-拔管技术(INSURE)PS给药联合咖啡因治疗,观察组采用微创肺表面活性物质给药技术(LISA)PS给药联合咖啡因治疗。比较两组治疗后24 h的疗效,患儿达到纠正年龄36周时的肺功能指标[潮气量(VT)、呼吸频率(RR)、分钟通气量(MV)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、25%、50%及75%潮气量时的呼气流速(FEF25%、FEF50%、FEF75%)]、治疗前与治疗后24h的呼吸力学指标[气道阻力、静态肺顺应性、内源性呼气末正压(PEEP)]、血气分析值[氧分压(PaO_(2))值、二氧化碳分压(PaCO_(2))值、pH]、患儿接受治疗的各项时间指标(呼吸困难消失时间、无创辅助通气总时间、住院时间)、用药期间不良反应及住院期间发症发生率。结果:治疗24h后,观察组疗效(94.3%)高于对照组(88.8%),患儿达到纠正年龄36周时RR、气道阻力与内源性PEEP低于对照组,MV、TPTEF/TE、VPEF/VE、FEF25%、FEF50%、FEF75%、静态肺顺应性均高于对照组,两组血气分析值部分指标均较治疗前有明显恢复,且观察组PaO_(2)与pH高于对照组,PaCO_(2)低于对照组(均P<0.05)。观察组住院时间(18.63±1.83d)少于对照组(20.57±2.07d)(均P<0.05)。各项不良反应及并发症的发生率两组无差别(P>0.05)。结论:INSURE技术与LISA技术PS给药联合咖啡因对NRDS早产儿均有一定疗效,但LISA技术疗效更好,对早产儿肺功能、呼吸功能及血气值均有良好影响,并能促进患儿康复,用药及住院期间未增加早产儿不良反应及并发症发生。

Objective:To compare the influence of the different techniques of pulmonary surfactant(PS)administration for treating premature infants with neonatal respiratory distress syndrome(NRDS)on their pulmonary function and adverse reactions.Methods:105 premature infants with NRDS selected and were divided into control group(n=52)and observation group(n=53)by simple randomization method with the help of random number table from August 2019 to August 2023.The infants in the control group were treated with PS administration by tracheal intubation-use of pulmonary surfactant-extubation technique(INSURE)combined with caffeine,while the infants in the observation group were treated with PS administration by minimally invasive pulmonary surfactant administration technique(LISA)combined with caffeine.The curative effect at 24h after treatment,the values of pulmonary function indexes at the time of the infants with the corrected age of 36 weeks,such as tidal volume(VT),respiratory rate(RR),minute ventilation(MV),time to peak value ratio(TPTEF/TE),peak volume ratio(VPEF/VE),expiratory flow at 25%,50%and 75%of tidal volume(FEF25%,FEF50%,FEF75%),the values of respiratory mechanics indexes before treatment and at 24hafter treatment,such as airway resistance,static lung compliance and endogenous positive endexpiratory pressure(PEEP),the values of blood gas analysis,such as partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2))and pH,the values of the time indexes of the infants received treatment,such as dyspnea disappeared time,total noninvasive ventilation time and the hospital stay,the adverse reactions rate during the medication and the incidence of complications during hospitalization of the infants were compared between the two groups.Results:After 24hours of treatment,the curative effect(94.3%)of the infants in the observation group was significantly higher than that(88.8%)of the infants in the control group.When the infants reached the corrected age of36weeks,the values of RR,airway resistance and endogenous PEEP of the infants in the observation group were significantly lower than those of the infants in the control group.The values of MV,TPTEF/TE,VPEF/VE,FEF25%,FEF50%and FEF75%,and the static lung compliance of the infants in the observation group were significantly higher than those of the infants in the control group.The values of some indexes of blood gas analysis of the infants in the two groups were significantly recovered compared with those before treatment.The PaO_(2)and pH values of the infants in the observation group were significantly higher than those of the infants in the control group,and the PaCO_(2) value of the infants in the observation group was significantly lower than that of the infants in the control group(all P<0.05).The time of hospital stay(18.63±1.83d)of the infants in the observation group was significantly shorter than that(20.57±2.07d)of the infants in the control group(all P<0.05).There were no significant differences in the various adverse reactions and the incidence of complications of the infants between the two groups(P>0.05).Conclusion:The PS administration by both INSURE technique and LISA technique combine with caffeine for treating the premature infants with NRDS are effective,but LISA technique is more effective,which has good influence on the pulmonary function,respiratory function and blood gas value of the premature infants,and can promote the rehabilitation of the infants,and without increase of the incidence of adverse reaction and complications of the infants during medication and hospitalization.