新生儿呼吸窘迫综合征应用肺表面活性物质治疗后并发症的对照研究

Incidence of Complications of the Respiratory Distress Syndrome Following Pulmonary Surfactant Replacement Therapy in Neonates

目的 探讨肺表面活性物质(PS)替代治疗新生儿呼吸窘迫综合征(RDS)的并发症发生情况。方法 采用前瞻性临床对照研究方法,将98例RDS患儿分为PS治疗组和对照组,研究两组机械通气的天数、氧疗时间、住院天数、存活率以及并发呼吸机相关性肺炎、动脉导管未闭、颅内出血、肺出血、肺气漏、支气管肺发育不良(BPD)及呼吸暂停的发生情况。结果 治疗组机械通气的天数、氧疗天数缩短[(9.5±6.2)d vs(7.0±5.4)d,(13.2±8.1)d vs(10.0±6.4)d],存活率由69.2％上升为87.0％,差异均具有显著性(P<0.05)。治疗组合并肺气漏发生率由32.7％下降为15.2％,呼吸机相关性肺炎由44.2％下降为23.9％,差异有显著性意义(P<0.05)。存活者中治疗组较对照组未合并BPD的比例由75.0％上升为92.5％,未合并颅内出血由77.8％上升为95.0％,同时未合并BPD和颅内出血的比例由58.3％上升为80.0％,其差异均有显著性意义(P<0.05)。结论PS替代治疗RDS可以明显缩短机械通气的天数、氧疗时间及提高存活率,降低气漏及呼吸机相关性肺炎发生率,降怠浪存活者中脑损害和肺损伤的发生率,提高了早产儿的生存质量。 [中国当代儿科杂志,2003,5(1):31—34]

Objective To study the complications of the respiratory distress syndrome (RDS) following pulmonary surfactant (PS) replacement therapy in neonates. Methods Ninety-eight newboms with RDS were assigned into the PS treatment group and the control group. The former, besides the usual treatment for the control group, received PS replacement. The duration of mechanical ventilation and oxygen treatment, survival rate, length of hospitalization and incidence of complications, including ventilator associated pneumonia, patent ductus arteriosus, lung hemorrhage, air leak, intracranial hemorrhage, bronchopulmonary dysplasia (BPD) and apnea were compared between the two groups. Results There were significant differences in the ventilation time [(7.0±5.4) days vs (9.5±6.2) days, P < 0.05) ], duration of the oxygen period [(10.0 ±6.4) days vs (13.2 ±8.1), P<0.05)] and survival rate [87.0% vs 69.2%, P <0.05)] in the PS treatment group compared with the control group. Significant differences were noted in the incidence of complications between the two groups; the PS treatment group had lower incidences of air leak and ventilator associated pneumonia [(15.2% vs 32. 7 % , 44.2 % vs 23. 9 % , respectively] (both P < 0.05). There were higher rates of cases without BPD or/and intracranial hemorrhage in the survivals of the PS treatment group compared with the central group [(75.0% vs92.5%, 77.8% vs 95.0%, 58.3% vs 80.0%, respectively] (all P <0.05). Conclusions Mechnical ventilation days and the length of the oxygen treatment period could be reduced and the survival rate could be increased by PS replacement therapy in newboms with RDS. PS replacement therapy can decrease the incidence of complications, and decrease brain and pulmonary injuries and improve the quality of life of premature newboms.