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。
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.
关键词
持续肺充气 /
呼吸窘迫综合征 /
早产儿 /
安全性
Key words
sustained lung inflation /
neonatal respiratory distress syndrome /
preterm infants /
security
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Aftab S,Gerdes J.Delivery room management of RDS[J] .J Pulmon Resp Med,2013,(S13):003.
[2] Sweet DG,Camielli V,Greisen G,et al.European consensus guidelines on the management of neonatalrespiratory distress syndrome in preterm infants-2013 update[J] . Neonatology,2013,103(4):353-368.
[3] 王彦蕊,王铭杰,余小河,等.影响INSURE技术治疗早产儿呼吸窘迫综合征疗效因素的临床分析[J] .临床儿科杂志,2015,33(7):621-626.
[4] Rastogi S,Rajasekhar H,Gupta A,et al.Factors affecting th e weaning from nasal CPAP in preterm neonates[J] .Int J Pediatr,2012:416073.
[5] Lista G,Fontana P,Castoldi F,et al.Dose sustained lung inflation at birth impove outcome of preterm infants at risk for respiratory distress syndrome?[J] .Neonatology,2011,99(1):45-50.
[6] 邵肖梅,叶洪瑁,丘小汕.实用新生儿学[M] .4版.北京:人民卫生出版社,2011:395-398.
[7] Murki S,Deorari A,Vidyasagar D.Use of CPAP and surfactant therapy in newborns with respiratory distress syndrome[J] .Indian J Pediatr,2014,81(5):481-488.
[8] Dani C,Corsini I,Bertini G,et al.The INSURE method in preterm infants of less than 30 weeks′ gestation[J] .J Matern Fetal Neonatal Med,2010,23(9):1024-1029.
[9] Dargaville PA,Aiyappan A,De Paoli AG,et al.Continuous positive airway pressure failure in preterm infants:incidence,predictors and consequences[J] . Neonatology,2013,104(1):8-14.
[10] Vento G,Pastorino R,Boni L,et al.Efficacy of a new technique-Intubate-Recruit-Surfactant-Extubate“IN-REC-SUR-E”in preterm neonates with respiratory distress syndrome:study protocol for a randomized controlledtrial[J] . Trials,2016,17:414.
[11] 覃晓菲,张晓,游楚明,等.肺复张策略在早产儿呼吸窘迫综合征中的应用[J] .中国新生儿科杂志,2016,31(6):418-421.
[12] Grasso C,Sciacca P,Giacchi V,et al. Effects of sustained lung inflation,a lung recruitment maneuver in primary acute respiratory distress syndrome,in respiratory and cerebral outcomes in preterm infants[J] .Early Hum Dev,2015,91(1):71-75
[13] Lista G,Boni L,Scopesi F,et al.Sustained lung inflation at birth for preterm infants:a randomized clinical trial[J] .Pediatrics,2015,135(2):e457-e464.
[14] Lindner W,Hogel J,Pohlandt F.Sustained pressure-contr olled inflation or intermittent mandatory ventilation in preterm infants in the delivery room?A randomized,controlled trial on initial respiratory support via nasopharyngeal tube[J] .Acta Paediatr,2005,94(3):303-309.
[15] El-Chimi MS,Awad HA,El-Gannasy TM,et al.Sustained versus intermittent lung inflation for resuscitation of preterm infants:a randomized controlled trial[J] .J Matern Fetal Neonatal Med,2016,2:1-6.
[16] 马旅明,何川,谭勇明,等.控制性肺膨胀肺复张法治疗呼吸窘迫综合征的临床应用[J] .吉林医学,2013,34(25):5163-5164.
[17] 许军,曹赋韬,陆肖娴,等.不同肺复张方法在ARDS治疗中的应用研究[J] .海南医学院学报,2012,18(11):1596-1598.
[18] 杨传忠,朱小瑜.持续性肺膨胀在新生儿复苏中的应用[J] . 中华实用儿科临床杂志,2017,32(14):1041-1044.
[19] Sobotka KS,Hooper SB,Allison BJ,et al.An initial sustai ned lung inflation improves the respiratory and cardiovascular transition at birth in preterm lambs[J] .Pediatr Res,2011,70(1):56-60.
[20] Schwaberger B,Pichler G,Avian A,et al.Do sustained lung inflationsduring neonatal resuscitation affect cerebral blood volume in preterm infants?A randomized controlled pilot study[J] .PLoS One,2015,10(9):e0138964.
基金
东莞市社会科技发展(重点)项目(201750715007468)
PDF(661 KB)
