羊膜腔内注射肺表面活性物质预防新生儿呼吸窘迫综合征的临床研究

Clinical Study on Intra-Amiotic Administration of Pulmonary Surfactant for Neonatal Respiratory Distress Syndrome Prophylaxis

目的 探讨羊膜腔内注射肺表面活性物质 (pulmonarysurfactant ,PS)预防新生儿呼吸窘迫综合征 (neonatalrespiratorydistresssyndrome ,NRDS)的临床效果及其安全性。 方法 将 45例产前证实胎肺不成熟的早产孕妇分为两组 ,研究组 15例 (其中 1例双胎 )将PS制剂注入羊膜腔内 ,并于数小时内结束分娩。对照组 3 0例产前不予PS注射。比较两组新生儿Apgar评分、NRDS的发生率、新生儿死亡率及住院时间的差别。 结果 研究组分娩新生儿 16例 ,对照组 3 0例 ,两组新生儿Ap gar评分差异无显著性。胃液泡沫试验显示胎肺成熟的比率研究组为 56.3 % (9/ 16) ,对照组 13 .3 %(4/ 3 0 ) ,两组比较差异有显著性 (P <0 .0 1)。研究组新生儿需持续气道正压通气 (CPAP)的比率为18.8% (3 / 16) ,NRDS的发生率为 6.3 % (1/ 16) ,均显著低于对照组 ,分别为 60 % (18/ 3 0 )和 3 6.7%(11/ 3 0 ) ,P <0 .0 5。研究组新生儿的住院时间均值为 (3 2 .4± 7.6)d ,比对照组 (42 .0± 15.7)d短约10d ,两组比较差异有显著性 (P <0 .0 5)。两组新生儿的死亡率无明显差异。研究组孕妇和新生儿均未发现由PS所导致的并发症及不良后果。 结论 羊膜腔内注射PS可显著地降低早产儿NRDS的发生率和CPAP的使用率 ,缩短住院时间 。

ObjectiveTo discuss the effects and security o f intra-anmiotic administration of pulmonary surfactant for neonatal respiratory distress syndrome prophylaxis.MethodsForty-five cases of pr eterm delivery with immature fetal lungs were divided into two groups. Fifteen w omen of the study group were administered one dose of pulmonary surfactant into the amniotic cavity and delivered in several hours. Nothing was injected into th e amniotic cavity of the 30 women in the control group. The proportion of NRDS, mortality and the time in hospital were analyzed to make clear whether there wer e any differences between the two groups.ResulstsThere was n o difference between the two groups for neonatal Apgar score. Foam test demonstr ated that the proportion of lung maturity of the neonates was:56.3%(9/16)in the study group, 13.3%(4/30)in the control group,(P<0.01). study neon ates 18.8%(3/16) need CPAP and 6.3%(1/16) had NRDS, while it was 60%(18/30) and 36.7% (11/30) respectively in control group, (P<0.05).The study neonate s spent nearly 10 days less in the hospital than the control(32.4±7.6 vs 42.0± 15.7 P<0.05 ), but the difference of the mortality between two groups was n ot significant.ConclusionIntra-amniotic administration of p ulmonary surfactant can significantly reduce the proportion of NRDS and time in hospital of preterm neonates. Whether this method can reduce the mortality of pr eterm neonates need further evaluation. Intra-amniotic administration of pulmon ary surfactant provides an additional effectual means of NRDS prophylaxis.