Abstract: Objective To study changes of treatment in preterm infants with respiratory distress syndrome (RDS) during 1998-2012. Methods Retrospective observational study of infants, <34 weeks gestation, born between January 1998 and December 2012.A group was the cases during the first 7 years(n=63), and B group was the cases during the next 8 years(n=151).Perinatal data, birth history treatment (including respiratory support, surfactant therapy and doses), complications and outcomes were compared. Results The birth weight of B group was (1 284.50±252.153)g, significantly lower than A group [(1 424.27±329.44)g](t=3.292, P<0.001).The amount of surfactant in group was (169.66±57.97) mg, significantly lower than that of B group [(195.00±59.87) mg](P=0.041).The requirement of intubation ventilation support in A group was 39 cases (90.7%), higher than 85 cases in B group (70.8%)(χ²=6.86, P<0.01).In group B, 33 cases (27.5%) developed BPD, which was more than 4 cases (9.3%) in A group (χ²=5.97, P=0.02).The length of hospitalization, NICU stay and oxygen dependence in B group were longer than A group.The mortality of B group was lower than A group, 11.7% versus 27.9% (χ²=6.23, P=0.01). Conclusion In the last decades, exogenous surfactant replacement has been established as an effective and safe therapy in RDS preterm infants.

Key words: respiratory distress syndrome, surfactant, preterm infants

摘要： 目的 回顾性分析新生儿病房1998-2012年来诊断为新生儿呼吸窘迫综合征(respiratory distress syndrome, RDS)的早产儿病例, 总结在治疗措施方面的进展。方法 回顾性病例对照研究, 1998年1月-2012年12月本院新生儿重症监护病房(NICU)收治的<34周新生儿呼吸窘迫综合征早产儿病例, 记录母孕期情况和围产期情况, 出生史和采用呼吸支持方式(有创或无创呼吸支持), 是否应用肺表面活性物质(pulmonary surfactant, PS), 用药剂量以及患儿的合并症和结局。结果 自1998年1月-2004年12月为A组, 63例;2005年1月-2012年12月病例为B组, 151例。B组患儿出生体重[(1 284.50±252.15)g]明显低于A组[(1 424.27±329.44)g](t=3.292, P<0.001), 分娩前应用激素促进肺成熟的病例数明显增加(B组139例, 92.1%;A组44例, 69.8%;χ²=17.704, P<0.001);B组应用PS总量为(195.00±59.87) mg, A组中应用PS总量为(169.66±57.97)mg, 两组间差异有统计学意义(P=0.041);计算PS与体重比值, B组为(147.71±42.09)mg/kg, A组为(115.86±37.11)mg/kg, 差异显著(P<0.01)。B组85(70.8%)应用有创呼吸支持, 较A组39例(90.7%), 显著降低(χ²=6.86, P<0.01)。B组33例(27.5%)诊断支气管肺发育不良(BPD), 较A组4例(9.3%)显著增高(χ²=5.97, P=0.02)。住院天数、NICU住院天数、氧疗天数都是B组显著长于A组。A组12例死亡, 病死率27.9%, 而B组14例死亡, 病死率11.7%, 两组比较差异有统计学意义(χ²=6.23, P=0.01)。结论 在过去十余年来, 随着分娩前应用激素促肺成熟及外源性表面活性物质的引入, 采用适宜的呼吸支持方式, 使越来越多的RDS早产儿得以存活。

关键词: 新生儿呼吸窘迫综合征, 肺表面活性物质, 早产儿