Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.

Effects of Different Surfactant Administrations on Cerebral Autoregulation in Preterm Infants with Respiratory Distress Syndrome

To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.

Effect of different ventilation methods combined with pulmonary surfactant on neonatal acute respiratory distress syndrome

BACKGROUND Acute respiratory distress syndrome precipitates is widespread pulmonary injury in impacted individuals,the neonatal respiratory distress syndrome(NRDS),primarily observed in preterm infants,represents a prevalent critical condition in neonatal clinical settings.AIM To investigate the clinical efficacy of various ventilation strategies combined with pulmonary surfactant(PS)therapy in the treatment of NRDS.METHODS A total of 20 neonates diagnosed with respiratory distress syndrome,admitted between May 2021 and June 2022,were randomly assigned to either a research group or a control group.Neonates in the research group received treatment involving high-frequency oscillatory ventilation(HFOV)in conjunction with PS.In contrast,neonates in the control group were administered either controlled mechanical ventilation or synchronous intermittent mandatory ventilation,combined with PS.Arterial blood samples from the neonates in both groups were collected before treatment,as well as 6 h,12 h,24 h,and 48 h post-treatment.These samples underwent blood gas analysis,with measurements taken for pH value,partial pressures of oxygen(O_(2))and carbon dioxide.Concurrently,data was collected on the duration of ventilator use,length of hospitalization time,O_(2) treatment time,treatment outcomes,and complications of the ventilator.RESULTS From 6-48 h post-treatment,both groups demonstrated significant improvements in arterial blood pH and oxygen partial pressure,along with a significant decrease in carbon dioxide partial pressure compared to pre-treatment values(P<0.05).Although these changes progressed over time,there were no significant differences between the two groups(P>0.05).However,the research group had significantly lower X-ray scores,shorter hospitalization time,and less time on O_(2) therapy compared to the control group(P<0.05).Mortality rates were similar between the two groups(P>0.05),but the research group had a significantly lower incidence of complications(P<0.05).CONCLUSION The integration of HFOV combine with PS has proven to effectively expedite the treatment duration,decrease the occurrence of complications,and secure the therapeutic efficacy in managing NRDS.

Surfactant Protein D for Pathological Evaluation of Infant Acute Respiratory Distress Syndrome Caused by Respiratory Syncytial Virus Infection

Pediatric respiratory syncytial viral infection (RS) usually shows relatively good outcome;however, when it accompanies acute respiratory distress syndrome (ARDS), this becomes fatal. We experienced three pediatric patients with RS + ARDS, with all showing good outcome with steroid pulse therapy. We wish to emphasize;1) steroid pulse therapy may become an option for this condition, and 2) plasma KL-6 and surfactant protein D levels may become a biomarker reflecting the disease progression/condition. Patients were, aged 1 month, 1 year 5 months, and 1 year 11 months. In all three, the respiratory condition deteriorated rapidly, requiring invasive ventilator management. Although the effectiveness of steroid treatment for ARDS is controversial, very severe condition prompted us to employ steroid pulse therapy, after which, oxygenation rapidly improved without adverse events. Plasma KL-6 and surfactant protein D levels were measured during exacerbations of ARDS, steroid pulse therapy, and recovery. Surfactant protein D levels were closely associated with oxygenation, suggesting this substance level might be a biomarker of ARDS caused by the disruption of the alveolar epithelial lining and to understand oxygenation without time lag.

Prophylaxis of neonatal respiratory distress syndrome by intra-amniotic administration of pulmonary surfactant

Background Neonatal respiratory distress syndrome (NRDS) is caused by a deficiency in pulmonary surfactant (PS) and is one of the main reasons of neonatal mortality. This study was conducted to evaluate the efficacy and safety of intra-amniotic administration of pulmonary surfactant for prophylaxis of NRDS. Methods Forty-five pregnant women who were due for preterm delivery and whose fetuses’ lungs proved immature were divided into two groups. Fifteen women (study group) were administered one dose of pulmonary surfactant injected into the amniotic cavity and delivered within several hours. Nothing was injected into the amniotic cavity of 30 women of the control group. The proportion of neonatal asphyxia,NRDS,mortality and the time in hospital were analyzed to determine if there was any difference between the two groups. Results There was no significant difference between the two groups for neonatal asphyxia. Foam tests showed that higher proportion of neonates in the study group than in the control group (56.3% vs 13.3%, P <0.05) had lung maturity. A greater number of control neonates (11/30,32.3%) had NRDS,compared with the neonates given PS via the amniotic cavity before delivery (1/16,6.3%, P <0.05). The neonates in the study group spent nearly 10 days less in hospital than the control group [(32.4±7.6) days vs (42.0±15.7) days,P <0.05],but the difference in mortality between the two groups was not statistically significant. Conclusions Intra-amniotic administration of pulmonary surfactant can significantly reduce the proportion of NRDS and the time in hospital of preterm neonates. Whether this method can reduce the mortality of preterm neonates needs to be evaluated further. Intra-amniotic administration of pulmonary surfactant provides an additional effectual means for NRDS prophylaxis.

Respiratory support for severe acute respiratory syndrome: integration of efficacy and safety

Severe acute respiratory syndrome （SARS） is an acute respiratory illness caused by infection with the SARS virus. The most obvious clinical characteristic of SARS is rapidly progressive pneumonia, and about 20% patients need intensive care due to acute lung injury （ALI） and acute respiratory distress syndrome （ARDS）.1-3 In the absence of effective drugs for SARS, supportive care, especially respiratory support techniques （RSTs）, is of primary importance. On the other hand, offering RSTs to SARS patients may carry a high-risk of infection to healthcare workers because of the high infectivity of SARS. Therefore, the strategy of RSTs for SARS should be the integration of efficacy and safety. In this issue of the Chinese Medical Journal, an article from Hong Kong has retrospectively compared both the safety and efficacy of noninvasive positive pressure ventilation （NIPPV） with that of invasive mechanical ventilation （IMV） in the treatment of respiratory failure in SARS.

LISA技术与INSURE技术治疗早产儿呼吸窘迫综合征的效果比较

目的:探讨微创注入肺表面活性物质(less invasive surfactant administration,LISA)与气管插管-肺表面活性物质-拔管(intubation-surfactant-extubate,INSURE)两种不同给药方法在早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)中的应用效果。方法:选取2019年1月1日—2022年8月31日江西省儿童医院收治的55例NRDS患儿,运用随机数字表法,分为LISA组(给予LISA技术,n=29)和INSURE组(给予INSURE技术,n=26)。比较两组治疗相关指标、并发症发生情况。结果:两组二次牛肺表面活性剂(CPS)使用率比较,差异无统计学意义(P>0.05);LISA组72 h内有创机械通气治疗率低于INSURE组,机械通气时间、总用氧时间及住院时间均短于INSURE组,差异均有统计学意义(P<0.05)。LISA组支气管肺发育不良(BPD)和早产儿视网膜病变(ROP)发生率均低于INSUR组,差异均有统计学意义(P<0.05),但两组其他并发症发生率比较,差异均无统计学意义(P>0.05)。结论:与INSURE技术相比,LISA技术治疗早产儿RDS,能有效降低有创机械通气率,缩短用氧时间,并减少BPD及ROP的发生。

微创表面活性物质注射技术联合无创通气在早产儿轻中度新生儿呼吸窘迫综合征中的应用

目的探讨微创表面活性物质注射(LISA)技术联合无创通气(NIPPV)在早产儿轻中度新生儿呼吸窘迫综合征(NRDS)中的应用效果。方法选取2022年3月至2023年3月江西省妇幼保健院收治的80例NRDS患儿为研究对象,采用随机数字表法分为常规组与研究组,每组各40例。其中常规组传统技术联合NIPPV进行治疗,研究组使用LISA技术联合NIPPV进行治疗,比较两组患儿疗效、血气指标[pH值、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))及氧合指数(OI)]、临床指标[再次肺表面活性物质(PS)治疗例数、72 h内机械通气例数、机械通气时间、住院时间]及并发症发生情况。结果研究组总有效率(97.50%)高于常规组(80.00%),差异有统计学意义(P<0.05);治疗后,研究组pH、PaO_(2)及OI值均高于常规组,PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。两组患儿再次PS发生率比较,差异无统计学意义(P>0.05)。研究组72 h内机械通气发生率低于常规组,机械通气时间及住院时间短于常规组,差异有统计学意义(P<0.05)。研究组并发症总发生率(5.00%)低于常规组(22.50%),差异有统计学意义(P<0.05)。结论在治疗早产儿轻中度NRDS患儿方面,LISA技术疗效确切,相较于传统技术其改善患儿血气指标的效果更加明显,同时可显著减少患儿机械通气次数及时间,缩短住院时间,并显著减少并发症的发生。

咖啡因联合经鼻高流量氧疗治疗新生儿呼吸窘迫综合征的疗效观察

目的 分析咖啡因联合经鼻高流量氧疗治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法 前瞻性选取2020年3月—2023年6月亳州市人民医院收治的98例NRDS患儿,按随机数字表法分为对照组和研究组,每组49例。对照组给予经鼻高流量氧疗,研究组在对照组基础上另给予枸橼酸咖啡因治疗,治疗后7 d观察效果。对比两组无创通气时间、总用氧时间、呼吸暂停次数、血气指标、呼吸力学指标、临床疗效、炎症因子及并发症情况。结果 研究组无创通气时间、总用氧时间、呼吸暂停次数均低于对照组(P <0.05)。研究组与对照组治疗前、治疗后3和7 d的二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))比较,结果:(1)不同时间点PaO2、PaCO_(2)比较,差异均有统计学意义(F=7.961和8.038,均P=0.000);(2)研究组与对照组PaO_(2)、PaCO_(2)比较,差异均有统计学意义(F=7.958和6.987,均P=0.000);(3)两组PaO_(2)、PaCO_(2)变化趋势比较,差异均有统计学意义(F=8.057和8.136,均P=0.000)。研究组与对照组治疗前、治疗后3和7 d的气道阻力、内源性呼气末正压比较,结果:(1)不同时间点气道阻力、内源性呼气末正压比较,差异均有统计学意义(F=7.854和8.126,均P=0.000);(2)研究组与对照组气道阻力、内源性呼气末正压比较,差异均有统计学意义(F=8.236和7.958,均P=0.000);(3)两组气道阻力、内源性呼气末正压变化趋势比较,差异均有统计学意义(F=7.968和8.027,均P=0.000)。研究组总有效率高于对照组(P <0.05)。研究组治疗前后骨形态发生蛋白-7、Clara细胞分泌蛋白16、肿瘤坏死因子-α、C反应蛋白的差值均高于对照组(P <0.05)。两组总并发症发生率比较,差异无统计学意义(P>0.05)。结论 咖啡因联合经鼻高流量氧疗治疗NRDS疗效显著,可改善患儿血气及呼吸力学指标,抑制炎症反应,安全可靠。

LISA技术对新生儿呼吸窘迫综合征患儿肺功能、血气指标及炎症因子的影响

目的探讨微创注入肺表面活性物质(LISA)技术对新生儿呼吸窘迫综合征(NRDS)患儿肺功能、血气指标及炎症因子的影响。方法选择潍坊市妇幼保健院新生儿科重症监护病房(NICU)2021年1月—2023年1月收治的80例NRDS患儿为研究对象,依照随机数字表法分成传统组(n=40)和LISA组(n=40)。传统组应用气管插管-肺表面活性物质给药-拔管(INSURE)技术治疗,LISA组采取LISA技术治疗。比较两组治疗前、治疗72 h后血气指标、炎症因子水平、肺功能,同时比较两组治疗相关指标、并发症情况及28 d病死率。结果治疗72 h后,两组动脉血二氧化碳分压(PaCO_(2))、血清超敏C反应蛋白(hs-CRP)、巨噬细胞移动抑制因子-1(MIF-1)水平均低于治疗前(P<0.05),且LISA组上述3项指标均明显低于传统组(P<0.05);治疗72 h后,两组动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))、白介素10(IL-10)水平、氧合指数(OI)、呼吸频率(RR)测定值均高于治疗前(P<0.05),且LISA组上述指标均明显高于传统组(P<0.05);LISA组72 h内机械通气率低于传统组(P<0.05),机械通气时间、氧疗时间、NICU入住天数、住院天数短于传统组(P<0.05),支气管肺发育不良(BPD)发生率(5.00%)低于传统组的20.00%(P<0.05);LISA组28 d病死率5.00%和传统组的12.50%比较无统计学差异(P>0.05)。结论对NRDS患儿采用LISA技术治疗,可有效改善血气指标、炎症状况,明显缩短氧疗时间及住院天数,显著提高肺功能,并有助于降低BPD发生风险。

经微创肺表面活性物质给药治疗早产儿呼吸窘迫综合征的效果及对动脉血气分析指标的影响

目的 分析经微创肺表面活性物质(LISA)给药治疗早产儿呼吸窘迫综合征(RDS)的效果及对动脉血气分析指标的影响。方法 选取2022年6月至2023年6月山西省儿童医院新生儿重症医学科收治的早产儿RDS148例,按随机数字表法分为常规给药组和微创给药组,各74例。微创给药组给予LISA治疗,常规给药组按照常规给药方法治疗。观察2组治疗情况、治疗前后动脉血气分析指标、住院期间并发症发生情况。结果 与常规给药组比较,微创给药组72 h内有创机械通气率、再次使用肺表面活性物质率更低(P <0.05),无创通气时间、住院时间更短(P <0.05)。与治疗前相比,治疗后2组动脉血氧分压(PaO2)、酸碱度(pH)升高(P <0.05),微创给药组高于常规给药组(P <0.05);2组动脉血二氧化碳分压(PaCO_(2))降低(P <0.05),微创给药组低于常规给药组(P <0.05)。与常规给药组比较,微创给药组支气管肺发育不良发生率更低(P <0.05)。结论 早产儿RDS经LISA治疗可改善治疗情况,改善动脉血气指标,控制并发症的发生风险。

枸橼酸咖啡因辅助PS治疗新生儿呼吸窘迫综合征对血清炎症因子及血气分析的影响分析

目的 分析枸橼酸咖啡因辅助肺表面活性物质(Pulmonary Surfactant,PS)治疗新生儿呼吸窘迫综合征(Neonatal Respiratory Distress Syndrome,NRDS)的临床疗效及对患儿血清炎症因子、肺功能的影响。方法 单纯随机选择2020年1月—2023年1月南通大学附属妇幼保健院儿科收治的80例NRDS患儿为研究对象,按不同治疗方法分为两组,每组40例。对照组采用PS治疗,观察组联合枸橼酸咖啡因辅助治疗,两组均治疗2周。比较两组临床疗效、血清炎性因子、血气指标、治疗效果及并发症发生情况。结果 观察组临床疗效(95.00%)高于对照组,差异有统计学意义(χ^(2)=5.165,P=0.023)。治疗后,观察组C反应蛋白、降钙素原、白细胞计数低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组pH、动脉血氧分压、氧合指数高于对照组,动脉血二氧化碳分压低于对照组,差异有统计学意义(P均<0.05)。观察组呼吸机使用时间、用氧时间、住院时间均短于对照组,差异有统计学意义(P均<0.05)。观察组呼吸暂停次数少于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论 对NRDS患儿使用枸橼酸咖啡因辅助PS治疗可有效改善患儿血气指标,减轻炎症反应,提高治疗有效率,安全可靠。

肺超声评分对晚期早产儿并发呼吸窘迫综合征应用机械通气及肺表面活性物质的预测价值

目的:探讨使用肺超声评分(LUS)对晚期早产儿并发呼吸窘迫综合征(RDS)应用机械通气(MV)和肺表面活性物质(PS)的预测价值。方法:选择并发RDS的晚期早产儿(胎龄34^(0/7)~36^(6/7)周)进行前瞻性分析,共纳入67例并发RDS的晚期早产儿。根据患儿生后48 h内是否需要应用MV和PS,分为MV组(n=36)、非MV组(n=31)、PS组(n=30)和非PS组(n=37)。各组患儿在入院后2 h和应用PS前进行肺超声检查,并分别计算6分区、10分区和12分区LUS。绘制不同分区LUS预测晚期早产儿并发RDS应用MV和PS的受试者工作特征(ROC)曲线,采用Delong检验比较不同分区方法的预测价值。结果:与非PS组比较,PS组患儿出生体质量、LUS、呼气末正压(PEEP)、平均气道压(MAP)、MAP×吸入氧浓度(FiO_(2))/动脉血分压(PaO_(2))比值、呼吸机使用时间和住院时间均升高(P<0.05或P<0.01),PaO_(2)/FiO_(2)比值降低(P<0.01)。与非MV组比较,MV组患儿出生体质量、LUS、PEEP、MAP、MAP×FiO_(2)/PaO_(2)值、呼吸机使用时间和住院时间均升高(P<0.05或P<0.01),PaO_(2)/FiO_(2)比值降低(P<0.01)。6分区LUS测PS应用时,PEEP、MAP和LUS是晚期早产儿并发RDS应用PS的危险因素[比值比(OR)>1,P<0.05]。10分区和12分区LUS预测PS应用时,MAP×FiO_(2)/PaO_(2)比值和LUS是晚期早产儿并发RDS应用PS的危险因素(OR>1,P<0.05)。6分区、10分区和12分区LUS预测MV应用时,MAP和LUS是晚期早产儿并发RDS应用MV的危险因素(OR>1,P<0.05)。6分区、10分区和12分区LUS预测晚期早产儿并发RDS的ROC曲线下面积(AUC)分别为0.909、 0.904和0.915,均具有较好的预测价值;使用6分区、10分区和12分区LUS预测晚期早产儿并发RDS应用MV的AUC分别为0.868、0.872和0.887,均具有较好的预测价值。结论:LUS可有效预测晚期早产儿并发RDS是否需要应用MV和PS,MAP联合LUS可以提高单独使用LUS预测应用MV的能力。

肺表面活性物质蛋白-B缺陷与足月新生儿呼吸窘迫综合征的相关性研究

目的探讨肺表面活性物质蛋白(surfactant protein,SP)-B缺陷与足月儿新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的相关性。方法2019年7月至2023年6月,在解放军总医院第七医学中心等4家医院开展研究。NRDS组纳入因患NRDS死亡的足月新生儿60例;对照组纳入同期因其他原因手术后死亡的足月、非NRDS患儿60例。采集胸部X线片结果。新生儿死亡后30 min内进行支气管肺泡灌洗、肺组织取材,采用蛋白质印迹法检测SP-B表达。统计学方法采用χ^(2)检验。结果NRDS组患儿生后出现严重高碳酸血症和低氧血症,采用外源性肺表面活性物质、有创高频振荡通气呼吸支持、一氧化氮治疗降低肺动脉高压等综合治疗措施,10例接受体外膜肺氧合治疗,均治疗无效死亡。NRDS组的X线胸片均显示白肺。NRDS组患儿支气管肺泡灌洗液中SP-B单体(分子质量8 ku)及二聚体(分子质量16~18 ku)表达阳性的比例均明显低于对照组[8 ku:75.0%(45/60)与100.0%(60/60),χ^(2)=17.143;16~18 ku:73.3%(44/60)与100.0%(60/60),χ^(2)=18.462;P值均<0.001];NRDS组肺组织中SP-B分子质量8 ku及16~18 ku表达阳性的比例也明显低于对照组[8 ku:75.0%(45/60)与100.0%(60/60),χ^(2)=17.143;16~18 ku:70.0%(42/60)与100.0%(60/60),χ^(2)=21.176;P值均<0.001]。NRDS组筛出SP-B缺陷个体15例,对照组仅1例,NRDS组SP-B缺陷的比例高于对照组[25.0%(15/60)与1.7%(1/60),χ^(2)=14.135,P<0.001]。结论SP-B缺陷与足月儿NRDS发病存在一定的相关性。

微创注入肺表面活性物质技术联合咖啡因治疗新生儿呼吸窘迫综合征临床观察

目的探讨微创注入肺表面活性物质(LISA)技术联合咖啡因治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选取河北省定州市人民医院2020年10月至2022年10月收治的NRDS患儿140例,按随机数字表法分为对照组和观察组,各70例。两组患儿均予咖啡因治疗,观察组患儿加用猪肺磷脂注射液(经LISA技术注入)治疗,比较两组的临床疗效。结果观察组总有效率为91.43%,显著高于对照组的75.71%(P<0.05)。治疗后,观察组患儿的血氧分压、血氧饱和度、氧合指数均显著高于对照组(P<0.05),血二氧化碳分压显著低于对照组(P<0.05);皮质氧饱和度、脑血氧定量指数、脑氧代谢率均显著高于对照组(P<0.05);Clara细胞分泌蛋白16、转化生长因子β1、肺表面活性物质相关蛋白A水平均显著低于对照组(P<0.05)。观察组并发症发生率为7.14%,显著低于对照组的21.43%(P<0.05)。结论微创注入LISA技术联合咖啡因治疗NRDS的临床疗效显著,可改善患儿的血气指标和脑代谢指标,抑制炎性反应,且安全性良好。

气管插管给药与气管插管-肺表面活性物质-拔管后经鼻持续气道正压通气给药治疗新生儿呼吸窘迫综合征的临床疗效比较

目的比较气管插管给药与气管插管-肺表面活性物质-拔管后经鼻持续气道正压通气(INSURE)给药治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选取2020年2月至2022年12月吉安市妇幼保健院收治的80例NRDS患儿作为研究对象,根据随机数字表法分为常规组与观察组,每组40例。常规组予以气管插管给药,观察组予以INSURE给药,比较两组临床疗效、肺功能[最大通气量(MVV)、第1秒用力呼气容积(FEV_(1))、呼气流量峰值(PEF)]、动脉血气指标[氧合指数(PaO_(2)/FiO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、并发症发生情况、治疗时间。结果观察组治疗总有效率为90.00%,高于常规组的70.00%,差异有统计学意义(P<0.05)。撤机后,两组MVV、FEV_(1)、PEF均大于上机前,且观察组大于常规组,差异有统计学意义(P<0.05)。撤机后,两组PaO_(2)、PaO_(2)/FiO_(2)均高于上机前,PaCO_(2)均低于上机前,且观察组PaO_(2)、PaO_(2)/FiO_(2)均高于常规组,PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。观察组并发症发生率为12.50%,低于常规组的32.50%,差异有统计学意义(P<0.05)。观察组吸氧时间、通气时间、住ICU时间、总住院时间均短于常规组,差异有统计学意义(P<0.05)。结论与气管插管给药治疗相比,INSURE给药治疗NRDS的效果更佳,可改善患儿肺功能及血气指标,降低并发症发生率,有利于促进患儿尽快恢复健康,值得临床推广应用。

肺表面活性物质治疗新生儿急性呼吸窘迫综合征的研究进展

新生儿急性呼吸窘迫综合征(nARDS)是新生儿期严重疾病之一,严重危害新生儿健康,其主要治疗手段包括呼吸机辅助通气、PS替代、抗感染及营养支持等。PS的替代治疗是新生儿急性呼吸窘迫综合征的独特治疗方式之一,PS的使用能显著改善患儿的低氧血症和呼吸窘迫。本文就nARDS的治疗过程中,PS的种类、剂量、给药途径、给药时机、重复给药等方面作一综述。

LISA技术治疗超低出生体质量儿呼吸窘迫综合征28例

目的探讨经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)下经微管气管内注入肺表面活性物质(less invasive surfactant administration,LISA)技术在超低出生体质量儿呼吸窘迫综合征(respiratory distress syndrome,RDS)治疗中的应用与疗效。方法采取前瞻性研究方法,选取潍坊市妇幼保健院新生儿科重症监护病房(neonatalintensive careunit,NICU)2019年7月至2021年4月收治的超低出生体质量儿(58例)为研究对象。应用随机数字表法分为LISA组(28例)和气管插管-注入PS-拔管给予经鼻持续气道正压通气(intubation-surfactant-extubation,INSURE)组(30例)。LISA组采用LISA技术,在nCPAP下,气管内置入微管并注入肺表面活性物质(pulmonarysurfactant,PS);INSURE组采用INSURE技术,拔管后给予nCPAP辅助通气。观察并比较两组病儿给药过程、给药前后呼吸机参数、动脉血气、用氧时间及并发症的发生率。结果LISA组病儿72 h内机械通气率低于INSURE组,差异有统计学意义(21.4%比46.7%,P=0.043);LISA组病儿住院期间无创正压通气时间(404.50 h比483.50 h,P=0.033)及总用氧时间(520.00 h比612.50 h,P=0.040)低于INSURE组;LISA组给药1 h后动脉血氧分压(arterial partialpressureof O_(2),PaO_(2))变化高于INSURE组[(54.29±5.69)mmHg比(52.87±3.27)mmHg,P=0.038],差异有统计学意义;LISA组支气管肺发育不良(25.0%比53.3%,P=0.028)及有血流动力学意义的动脉导管未闭发生率(28.6%比56.7%,P=0.031)低于INSURE组,均差异有统计学意义。结论在超低出生体质量儿RDS治疗中,LISA技术在减少72 h内机械通气率、住院期间用氧时间、近期并发症等方面具有优势,是一种安全有效的治疗超低出生体质量儿RDS的方法。

分析肺表面活性物质治疗重症新生儿呼吸窘迫综合征的临床效果

目的分析针对重症新生儿呼吸窘迫综合征实施肺表面活性物质治疗的临床效果。方法50例重症新生儿呼吸窘迫综合征患儿为研究对象,按照随机数字表法分为参考组和讨论组,每组25例。参考组患儿采用常规治疗,讨论组患儿采用肺表面活性物质治疗。比较两组患儿血气分析指标、不良事件发生情况以及治疗效果。结果治疗后,讨论组血液酸碱度(7.36±0.38)、动脉血氧分压(72.05±6.38)mm Hg(1 mm Hg=0.133 kPa)、血氧饱和度(96.83±1.71)%高于参考组的(7.19±0.18)、(64.42±6.07)mm Hg、(90.63±1.63)%,动脉血二氧化碳分压(40.28±2.53)mm Hg、吸入氧浓度(31.72±3.26)%低于参考组的(45.71±2.27)mm Hg、(40.63±3.58)%(P<0.05)。讨论组患儿不良事件发生率8.00%低于参考组的32.00%(P<0.05)。讨论组患儿治疗总有效率96.00%明显高于参考组的76.00%(P<0.05)。结论针对重症新生儿呼吸窘迫综合征采取肺表面活性物质进行治疗,可有效改善患儿血气分析指标,提升治疗效果,并且具有较高的安全性,对于改善患儿预后有重要作用。