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| 早期抢救性使用牛肺表面活性物质对早产儿严重呼吸窘迫综合征的疗效 |
| 王模奎1,董文斌2,黄薇1,苏华英1,杨介梅1,王琴1,吕勇彬1,卢婷1 |
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| (1.宜宾市第一人民医院,四川宜宾 644000;2.西南医科大学附属医院,四川泸州 646000) |
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| 摘要: |
| 目的:探讨早期抢救性使用牛肺表面活性物质(PS)对早产儿严重呼吸窘迫综合征(RDS)的疗效,以期为临床治疗提供参考。方法:回顾性分析我院2012年1月至2016年5月NICU住院的抢救性使用牛PS的早产儿严重RDS病例86例。收集患儿的一般情况、PS使用情况、住院时间、氧疗时间、机械通气时间、经鼻持续气道正压通气(nCPAP)时间、使用PS前后的氧合指数(OI)、生后28 d的存活率和并发症发生情况。按首次使用PS时的年龄将患儿分为早期组(生后1~2 h给药,40例)和延迟组(≥2 h 给药,46例)。结果:早期组和延迟组的一般情况、使用PS前的OI、住院时间和nCPAP时间、nCPAP使用率、肺出血等并发症发生率比较差异无统计学意义(P>0.05)。使用PS后,两组病例OI均持续改善,但只有12 h和72 h与前一个时间点的OI比较差异有统计学意义(P<0.01)。86例患儿中存活74例,总体存活率为86.0%。早期组存活率为95.0%,显著高于延迟组的78.3%(χ2=4.99,P<0.05)。早期组与延迟组支气管肺发育不良(BPD)发生率分别为2.5%、19.6%,机械通气时间分别为120.0(96.0,143.0)h、133.0(72.0,148.0)h,氧疗时间分别为8.0(7.0,12.0)d、12.0(8.0,15.0)d,PS重复使用率分别为57.5%、80.4%,重复使用PS间隔时间分别为20.0(18.0,22.0)h、19.0(18.0,20.0)h (P均<0.05)。结论:早期抢救性使用牛PS不仅能降低严重RDS早产儿的病死率与BPD发生率,减少机械通气和氧疗时间,还能减少PS的重复使用率,延长需重复使用PS的间隔时间。 |
| 关键词: 早期 早产儿 呼吸窘迫综合征 牛肺表面活性物质 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2017.06.005 |
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| 基金项目: |
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| Early Salvaged Using of Bovine Pulmonary Surfactant on Preterm Infants with Severe Respiratory Distress Syndrome |
| Wang Mokui1 , Dong Wenbin2 , Huang Wei1 , Su Huaying1 , Yang Jiemei1 , Wang Qin1 , Lyu Yongbin1 , Lu Ting1 |
| (1. The First People爷s Hospital of Yibin, Sichuan Yibin 644000, China; 2. The Affiliated Hospital of Southwest Medical University, Sichuan Luzhou 646000, China) |
| Abstract: |
| Objective: To evaluate the efficacy of early salvaged using of bovine pulmonary surfactant (PS) on preterm infants with severe respiratory distress syndrome (RDS), to offer the information for clinical treatment. Methods: Retrospected analysed the children's data of 86 preterm infants, who had been admitted to NCIU and with bovine PS salvaged using because of severe RDS, from January 2012 to May 2016.Data were collected, such as general information, usage of PS, duration of hospital stay, the time of oxygen therapy, mechanical ventilation, and nasal continuous positive airway pressure (nCPAP), oxygenation index(OI)before and after PS administration, survival rate of 28 days after birth, complication. All the children were divided into early group (<2 h) and delayed group (≥2 h) according to the age when the onset of the first dose of PS administration, respectively. Results: The general information, OI before PS administration, duration of hospital stay and the time of nCPAP, the rate of nCPAP and complications such as pulmonary hemorrhage had no significant differences between the two groups (all P>0.05). The OI were continue decreased in the two groups, but only OI in 12 h and 72 h were significantly lower than before. There were 74 (86.0%) survivors in all the 86 cases, and the survival rate was 95.0% in early group, significantly higher than that of 78.3% in delayed group (χ2 =4.99, P<0.05). In early group and delayed group, the rates of bronchopulmonary dysplasia (BPD) were 2.5% and 19.6%, duration of mechanical ventilation were 120.0 (96.0, 143.0) h and 133.0 (72.0, 148.0) h, the time of oxygen therapy were 8.0 (7.0, 12.0) d and 12.0 (8.0, 15.0) d, the rate of PS reuse were 57.5% and 80.4%, and the interval of PS reuse were 20.0 (18.0, 22.0) h and 19.0 (18.0, 20.0) h, respectively (all P<0.05). Conclusion: Early salvaged using of bovine PS, not only significantly decrease the mortality and rate of BPD, the duration of mechanical ventilation and oxygen therapy, but also delay the interval and reduce the opportunity of repeated PS in preterm infants with severe RDS. |
| Key words: early preterm infant respiratory distress syndrome bovine pulmonary surfactant |
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