糖皮质激素的两种给药方案对NRDS疗效的影响

目的 探讨糖皮质激素支气管滴注和雾化吸入给药对新生儿呼吸窘迫综合征(NRDS)患儿血气分析指标、有创通气率及支气管肺发育不良(BPD)发生率的影响.方法 选取武汉大学人民医院儿科2015年5月至2016年5月收治的NRDS患儿共110例,以随机数字表法分为A组(55例)和B组(55例),在肺表面活性物质(PS)应用基础上分别给予布地奈德支气管滴注和雾化吸入治疗,比较两组患儿近期疗效,治疗前后血气分析指标和氧合指标水平、辅助通气持续时间、有创通气率及BPD发生率等.结果 B组患儿治疗24h后疗效显著优于A组(χ2=4.274,P<0.05).B组患儿治疗后4h、8h、24h血气分析指标水平均显著优于A组动脉血氧分压(PaO2):t值分别为2.120、1.748、2.086,均P<0.05;二氧化碳分压(PaCO2):t值分别为2.898、2.650、3.372,均P<0.05],B组患儿治疗后4h、8h、24h氧合指标水平均显著高于A组(OI:t值分别为2.980、3.319、2.744,均P<0.05;动脉/肺泡氧分压比值:t值分别为2.678、3.174、3.090,均P<0.05).B组患儿有创通气率、BPD发生率均显著低于A组(χ2值分别为7.210、4.853,均P<0.05).结论 糖皮质激素雾化吸入给药方案治疗NRDS可有效减轻临床症状体征,改善血气分析和氧合指标,并有助于降低有创通气和BPD发生风险,优于支气管滴注给药方案.

Influence of two glucocorticoid administration schemes on therapeutic effect of neonatal respiratory distress syndrome

Objective To investigate the influence of bronchial instillation and atomization inhalation of glucocorticoidon on blood gas analysis index , invasive ventilation rate and bronchopulmonary dysplasia ( BPD ) incidence in cases of neonatal respiratory distress syndrome ( NRDS) .Methods Altogether 110 cases of NRDS admitted in pediatrics department in Hubei People ' s Hospital Affiliated to Huhan University from May 2015 to May 2016 were chosen and divided into group A ( 55 cases ) and group B ( 55 cases ) with random number table method .Cases in group A were given budesonide by bronchial instillation and cases in group B were provided with atomization inhalation on basis of pulmonary surfactant (PS) treatment.Short-term therapeutic effect, blood gas analysis index and oxygenation index before and after treatment , duration of assisted ventilation , invasive ventilation rate and BPD incidence were compared between two groups . Results Therapeutic effect of cases in group B at 24 hours after treatment was significantly better than that in group A (χ2 =4.274, P<0.05).Blood gas analysis index at 4h, 8h and 24h after treatment in group B was obviously better than that in group A (PaO2:t value was 2.120, 1.748 and 2.086, respectively, all P<0.05; PaCO2: t value was 2.898, 2.650 and 3.372, respectively, all P<0.05). Oxygenation index at 4h, 8h and 24h after treatment in group B was better than that in group A ( OI: t value was 2.980, 3.319 and 2.744, respectively, all P<0.05;arterial alveolar oxygen partial pressure ratio:t value was 2.678, 3.174 and 3.090, respectively, all P<0.05).Invasive ventilation rate and BPD incidence in group B were significantly lower than those in group A (χ2 value was 7.210, and 4.853, respectively, both P<0.05).Conclusion Treatment of NRDS with glucocorticoid administrated through atomization inhalation can effectively relieve clinical symptoms and signs , improve blood gas analysis and oxygenation indexes , and reduce risks of invasive ventilation and BPD .It is better than adminstration through bronchial instillation .