持续肺充气对早产低出生体重儿呼吸窘迫综合征干预的安全性研究

doi:10.11852/zgetbjzz2018-1518

中国儿童保健杂志 ›› 2019, Vol. 27 ›› Issue (10): 1079-1083.DOI: 10.11852/zgetbjzz2018-1518

持续肺充气对早产低出生体重儿呼吸窘迫综合征干预的安全性研究

阮敏仪^1*, 饶红萍^2*, 杨勇¹, 张兰¹, 苏锦珍¹, 李敏许¹

1 东莞市妇幼保健院新生儿科,广东东莞 523000;
2 惠州市中心人民医院新生儿科,广东惠州 516000

收稿日期:2018-12-26 发布日期:2019-10-10 出版日期:2019-10-10
通讯作者: 李敏许,E-mail:dgminxu@163.com
作者简介:阮敏仪(1983-),广东人,主治医师,医学学士,主要研究方向为新生儿呼吸系统疾病。
注:^*共同第一作者。
基金资助:
东莞市社会科技发展(重点)项目(201750715007468)

Study on the clinical security of sustained lung inflation in low-birth-weight preterm infants with neonatal respiratory distress syndrome

RUAN Min-yi^1*, RAO Hong-ping^2*, YANG Yong¹, ZHANG Lan¹, SU Jin-zhen¹, LI Min-xu¹

1 Department of Neonatology,Dongguan Maternal and Child Health Care Hospital,Dongguan,Guangdong 523000,China;
2 Department of Neonatology,Huizhou Central People′s Hospital,Huizhou,Guangdong 516000,China

Received:2018-12-26 Online:2019-10-10 Published:2019-10-10
Contact: LI Min-xu,E-mail:dgminxu@163.com

摘要/Abstract

摘要： 目的分析持续肺充气(SLI)在治疗新生儿呼吸窘迫综合征(NRDS)的早产低出生体重儿的临床安全性,为NRDS的临床诊治提供参考。方法选择2017年5月-2018年9月东莞市妇幼保健院新生儿重症监护病房中NRDS早产儿80例,随机分为对照组(40例)和试验组(40例),对照组(IN-SUR-E组)气管插管注入肺表面活性物质(PS),拔管后行经鼻持续气道正压通气(nCPAP),试验组(IN-SLI-SUR-E组)气管插管给予SLI后再注入PS,拔管后行nCPAP,比较两组患儿的临床治疗效果及治疗后颅内出血、肺气漏、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、动脉导管未闭(PDA)、新生儿坏死性小肠结肠炎(NEC)等并发症的发生情况。结果试验组生后72 h无创通气成功例数多于对照组,差异具有统计学意义(P=0.021),同时试验组有创机械通气时间较对照组短,差异有统计学意义(P=0.038)。两组颅内出血发生率、肺气漏发生率、BPD发生率、ROP发生率、PDA发生率、NEC发生率及死亡率的差异无统计学意义(P>0.05)。两组血气pH、PaO₂、PCO₂、BE均随时间而变化(P<0.05),但组间差异无统计学意义(P>0.05)。结论 SLI用于治疗新生儿呼吸窘迫综合征可降低生后72 h有创机械通气率,缩短有创机械通气时间,但并不增加其肺气漏、颅内出血、BPD、ROP、PDA、NEC等并发症的发生率,治疗安全有效。

关键词: 持续肺充气, 呼吸窘迫综合征, 早产儿, 安全性

Abstract: Objective To study the clinical security of sustained lung inflation(SLI) in neonatal respiratory distress syndrome(NRDS) for preterm neonates,in order to provide evidence for clinical treatment. Methods A total of 80 NRDS infants in Dongguan Maternal and Child Health Care Hospital were enrolled in this study from May 2017 to September 2018,and were randomly divided into control group and experimental group,with 40 cases in each group.The experimental group received SLI after intubation,and then pulmonary surfactant prolonged the process of intubate-surfactant-extubate(INSURE).While the control group was given INSURE under the failure of nasal continuous positive airway pressure(nCPAP).The clinical treatment efficacy and complications,including intracranial hemorrhage,pulmonary air leakage,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),patent ductus arteriosus(PDA),neonatal necrotizing entercolitis(NEC),were compared between the two groups. Results The cases of the success of nCPAP within 72 hours after birth in experimental group was more than that in control group(P=0.021),and the time for invasive mechanical ventilation of experimental group was significantly shorter than that in control group(P=0.038).There were no statistically significant differences on the incidence of intracranial hemorrhage,pulmonary leakage,BPD,ROP,PDA,NEC and mortality between the two groups(P>0.05).The time effect on the change of blood gas indexes including pH,PaO₂,PCO₂ and BE of the two groups was significant(P＜0.05),while the intervention effect was not significant(P>0.05). Conclusion SLI as a treatment for NRDS,can reduce the invasive mechanical ventilation rate and shorten the invasive mechanical ventilation time within 72 hours after birth,whereas it does not increase the incidence of pulmonary air leakage,intracranial hemorrhage,BPD,ROP,PDA,NEC and other complications.

Key words: sustained lung inflation, neonatal respiratory distress syndrome, preterm infants, security

中图分类号:

R722.6

阮敏仪, 饶红萍, 杨勇, 张兰, 苏锦珍, 李敏许. 持续肺充气对早产低出生体重儿呼吸窘迫综合征干预的安全性研究[J]. 中国儿童保健杂志, 2019, 27(10): 1079-1083.

RUAN Min-yi, RAO Hong-ping, YANG Yong, ZHANG Lan, SU Jin-zhen, LI Min-xu. Study on the clinical security of sustained lung inflation in low-birth-weight preterm infants with neonatal respiratory distress syndrome[J]. journal1, 2019, 27(10): 1079-1083.

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持续肺充气对早产低出生体重儿呼吸窘迫综合征干预的安全性研究

Study on the clinical security of sustained lung inflation in low-birth-weight preterm infants with neonatal respiratory distress syndrome

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