肺表面活性物质联合布地奈德治疗早产儿呼吸窘迫综合征改善短期呼吸系统合并症的疗效

目的回顾性分析出生后早期以肺表面活性物质(PS)为载体气管内滴入布地奈德治疗早产儿呼吸窘迫综合征(RDS)改善早产儿短期呼吸系统合并症的有效性。方法采用回顾性研究方法,选取2014年1月至2018年12月本院新生儿重症监护病房(NICU)1 h内收治的胎龄26~32周、生后呼吸困难进行性加重诊断为RDS的早产儿为研究对象,将应用PS时加布地奈德作为PSBu组,仅用PS作为PS组。比较两组临床基本信息、RDS治疗情况、短期呼吸系统合并症(肺出血、气漏、呼吸机相关性肺炎、支气管肺发育不良)发生率及其他合并症和存活率等。结果符合入组标准128例,PSBu组61例,PS组67例,两组临床基本信息比较无统计学差异,具有可比性(P均>0.05)。PSBu组无创通气和总用氧时间均小于PS组,PSBu组呼吸机相关性肺炎发生率(14.8%)明显低于PS组(29.9%),PSBu组轻-中度支气管肺发育不良发生率(31.1%)也显著低于PS组(52.2%),差异均有统计学意义;两组肺出血、气漏及其他合并症发生率和存活率差异均无统计学意义。结论出生后早期以PS为载体气管内滴入布地奈德,缩短了RDS早产儿无创通气和总吸氧时间,降低了呼吸机相关性肺炎和轻-中度支气管肺发育不良发生率,肺出血及气漏无明显降低,部分改善了RDS早产儿短期呼吸系统合并症,且未增加其他疾病和死亡的发生风险。

Pulmonary surfactant combined with budesonide in the treatment of premature infants with respiratory distress syndrome-the curative effect of short-term respiratory complications

Objective To analyze the efficiency of intratracheal instillation of budesonide with pulmonary surfactant(PS)as a carrier for treating neonatal respiratory distress syndrome(RDS)among preterm infants and to investigate the effectiveness of improving short-term respiratory complications.Methods Using retrospective study method,preterm infant with gestational age from 26~32 weeks and progressive dyspnea after birth diagnosed as RDS in neonatal intensive care unit(NICU)of Peking University Third hospital from January 2014 to December 2018 were selected as the study subjects.Application of PS and budesonide was used in Group PSBu,and only PS used in Group PS.The basic clinical information,RDS treatment,incidence of short-term respiratory complications(pulmonary hemorrhage,air leakage,ventilator-associated pneumonia,bronchopulmonary dysplasia),other complications and survival rates were compared between the two groups.Results Among 128 cases,61 cases in the PSBu group and 67 cases in the PS group.There was no statistical difference in basic clinical information between the two groups(all P>0.05).The duration of noninvasive ventilator and total oxygen use in PSBu group was lower than that in PS group,with statistical difference(P<0.05).The incidence of ventilator-associated pneumonia in PSBu group was significantly lower than that in PS group(14.8%vs 29.9%).The incidence of mild-to-moderate bronchogenic dysplasia in PSBu group was significantly lower than that in PS group(31.1%vs 52.2%,).There was no significant differences in the incidences of pulmonary hemorrhage,air leakage and other complications and survival rate between the two groups(all P>0.05).Conclusion Intratracheal instillation of budesonide with PS as carrier in early postnatal period can shorten the duration of noninvasive ventilation and total oxygen inhalation,reduce the incidence of ventilator-associated pneumonia and mild to moderate bronchopulmonary dysplasia,while there is no significant reduction in pulmonary hemorrhage and air leakage,which partially improved the short-term respiratory complications without the increasement the risk of other diseases and death.