摘要
目的探讨低侵入性肺表面活性物质治疗(less invasive surfactant administration,LISA)技术联合经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效及安全性。方法选择2019年10月至2021年11月徐州市中心医院新生儿监护病房收治的胎龄≤34周的RDS早产儿进行前瞻性研究,随机(随机数字法)分为LISA+NIPPV组和气管插管-使用肺表面活性物质-拔管(intubation-surfactant-extubation,INSURE)+经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)组。LISA+NIPPV组在NIPPV支持下,经喉镜气管内置入LISA管,注入肺表面活性物质(pulmonary surfactant,PS)。INSURE+NCPAP组暂停NCPAP支持,采取INSURE技术给予PS后继续给予NCPAP治疗。比较两组注入PS后1 h、6 h的血气分析、操作过程中的不良反应、临床疗效和支气管肺发育不良(bronchopulmonary dysplasia,BPD)等并发症。结果共纳入RDS早产儿112例,LISA+NIPPV组58例,INSURE+NCPAP组54例。①LISA+NIPPV组注入PS后1 h、6 h的血氧分压(PaO_(2))及PaO_(2)/吸入氧气分数(FiO_(2))(P/F)显著高于INSURE+NCPAP组相应时间点,二氧化碳分压(PaCO_(2))则显著低于INSURE+NCPAP组,差异均有统计学意义(P<0.05)。②与INSURE+NCPAP组相比,LISA+NIPPV组72 h内气管插管机械通气率(15.5%vs.33.3%)、无创呼吸支持时间[(7.5±4.3)d vs.(9.9±5.5)d]、总用氧时间[(10.5±3.5)d vs.(13.3±4.1)d]、撤机失败率(8.6%vs.31.0%)、呼吸暂停次数[7.0次(3.0~21.0次)vs.15.0次(4.0~28.0次)]及2次使用PS率(17.2%vs.33.3%)均降低,差异均有统计学意义(P<0.05)。③LISA+NIPPV组PS反流发生率低于INSURE+NCPAP组(13.8%vs.35.2%),差异有统计学意义(P<0.05),两组置管所用时间差异无统计学意义(P>0.05)。④LISA+NIPPV组患儿BPD发生率低于INSURE+NCPAP组(10.3%vs.25.9%),差异有统计学意义(P<0.05);其他并发症比较,差异均无统计学意义(P>0.05)。结论L
Objective To evaluate the efficacy and safety of less invasive surfactant administration(LISA)combined with nasal intermittent positive pressure ventilation(NIPPV)in the treatment of infants with respiratory distress syndrome(RDS).Methods A prospective study was conducted on preterm infants of gestational age≤34 weeks with RDS who were admitted to the Neonatal Intensive Care Unit of Xuzhou Central Hospital from October 2019 to November 2021.The infants were randomly assigned into the LISA+NIPPV group and the intubation-surfactant-extubation(INSURE)+nasal continuous positive airway pressure(NCPAP)group.In the LISA+NIPPV group,with the support of NIPPV,a Lisa tube was inserted through the vocal cords under direct vision with direct laryngoscope,and then pulmonary surfactant(PS)was infused into the lung.In the INSURE+NCPAP group,the patients were endotracheally intubated and infused with PS into the lung through endotracheal tube,then extubated and continued to receive NCPAP therapy(INSURE).The blood gas analysis at 1 h and 6 h after PS infusion,the adverse reactions during injection,clinical efficacy,bronchopulmonary dysplasia(BPD)and other related complications were compared between the two groups.Results A total of 112 preterm infants with RDS were enrolled,including 58 in the LISA+NIPPV group and 54 in the INSURE+NCPAP group.The blood oxygen partial pressure(PaO_(2))and PaO_(2)/FiO_(2)(P/F)in the LISA+NIPPV group were significantly higher than those in the INSURE+NCPAP group at 1 h and 6 h after PS infusion,while carbon dioxide partial pressure(PaCO_(2))were signifi cantly lower than that in the INSURE+NCPAP group,and the differences were statistically signifi cant(all P<0.05).The rate of tracheal intubation within 72 h(15.5%vs.33.3%),the duration of non-invasive ventilation[(7.5±4.3)d vs.(9.9±5.5)d],total oxygen inhaling[(10.5±3.5)d vs.(13.3±4.1)d],failure rate of machine withdrawal(8.6%vs.31.0%),the times of apnea[7.0(3.0-21.0)times vs.15.0(4.0-28.0)times]and re-administration of PS(17.2%vs.33.3%)in the
作者
金宝
周彬
马秀慧
吴杰斌
王云
张心
Jin Bao;Zhou Bin;Ma Xiuhui;Wu Jiebing;Wang Yun;Zhang Xin(Department of Neonatology,Xuzhou Central Hospital(Xuzhou Clinical College of Xuzhou Medical University),Xuzhou 221009,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2023年第6期748-754,共7页
Chinese Journal of Emergency Medicine
基金
徐州市科技局重点研发计划(社会发展KC18188)。
