LISA技术治疗早产儿呼吸窘迫综合征临床观察

目的:观察采用 LISA 技术治疗早产儿呼吸窘迫综合征(RDS)的临床疗效。 方法:回顾性分析 2014 年 5 月至 2016 年4 月我院收治并确诊为呼吸窘迫综合征、胎龄在 28 ~32 周的 RDS 早产儿共 87 例,根据治疗方法不同分为传统组和微创组。 传统组采用 INSURE 技术,即先行气管插管后再将肺表面活性物质(PS)注入,注入完毕后拔出气管插管,改为持续正压通气(CPAP)辅助呼吸;微创组为出生后即给予双水平正压通气(DuoPAP)辅助呼吸,将胃管置入气管内,PS 通过注射器针头缓慢经胃管注入,同时应用 DuoPAP 辅助呼吸,注入完毕后拔出胃管,继续 DuoPAP 辅助呼吸。 比较两组患儿二次 PS 应用、药物反流比例,气漏、支气管肺发育不良(BPD)发生率及胸部 X 线片改变、机械通气比例情况。 结果:微创组发生药物反流的比例低于传统组,差异有统计学意义(P<0.05)。 微创组需要二次应用 PS 的比例明显低于传统组,差异有统计学差异(P<0.05);传统组 5 例需机械通气,微创组 0 例,两组比较差异有统计学意义(P<0.05);两组患儿 BPD、气漏发生率及胸部 X 线片改变比较差异无统计学意义(P>0.05)。 结论:采用 LISA 技术治疗早产儿 RDS 可有效缓解患儿呼吸窘迫,保证 PS 用药剂量的准确性,减少住院费用,降低机械通气率,避免气管插管导致的肺损伤。

Less Invasive Surfactant Administration Technology in Treating Preterm Infants with Respiratory Distress Syndrome

Objective: To observe the efficacy of less invasive surfactant administration (LISA) technology in treating preterm infantswith respiratory distress syndrome (RDS). Methods: Eighty-seven RDS children born at 28 to 32 weeks were analyzed retrospectivelyfrom May 2014 to April 2016 in our hospital. The traditional group was treated with INSURE technology, injected pulmonary surfactant(PS) after the trachea cannula, took out the trachea cannua, made the continuous positive-pressure ventilation for assisted respiration.The minimally invasive group was treated with LISA technology, the bilevel positive airway pressure (DuoPAP) for assisted respiration was applied after birth, put the stomach tube into the trachea, injected PS into the stomach tube through the syringe needle with the DuoPAP for assisted respiration, took out the stomach tube after the injection, compared the secondary application of the PS between the two groups infants, the drug reflux rate, rate of air leak, the BPD incidence rate, the X-ray change in chest, mechanical ventilation rate. Results: The rate of the drug reflux in the minimally invasive group was lower than that of the traditional group, and the difference was statistically significant (P<0.05). The rate of the secondary application of the PS was obviously lower than that of the traditional group, and the difference was statistically significant (P<0.05). Five cases in the traditional group needed mechanical ventilation,while 0 case in the minimally invasive group, and the difference between the two groups was statistically significant (P<0.05). The differences of the BPD incidence rate, rate of air leak, the X-ray change between the two group had no statistic significance.Conclusion: Using LISA technology in treating RDS is feasible. Moreover, early invasive mechanical ventilation exposure is significantly reduced by this method, which can ensure the accuracy of PS''s dosage, reduce the hospitalized expense and mechanical ventilation rate, avoid the lung injury during tracheal cannula.