肺表面活性物质对不同胎龄呼吸窘迫综合征新生儿的疗效

目的 探讨肺表面活性物质(PS)对不同胎龄儿呼吸窘迫综合征(RDS)的疗效差异.方法 选择胎龄28～39周,出生体质量760～3 240 g,经PS治疗的RDS患儿67例.早期组:胎龄28～30周的早期早产儿18例;中期组:胎龄31～33周的中期早产儿28例;晚期组:胎龄34周以上的晚期早产儿和足月儿21例.比较3组PS治疗时RDS的重症程度、PS开始使用时间、第1次使用剂量、总剂量、重复使用例数、氧疗时间、最高吸氧体积分数(FiO2)、机械通气时间等指标.结果 PS治疗时早期组和中期组轻度RDS例数明显多于晚期组(Pa＜0.05).中期组和晚期组重度RDS例数明显多于早期组(Pa＜0.05),PS开始使用时间晚期组明显晚于早、中期组(Pa＜0.05).第1次使用剂量早期组明显多于中、晚期组(Pa＜0.05).使用总剂量和重复使用例数各组间均无统计学差异(Pa＞0.05).机械通气时间早、晚期组明显多于中期组(P=0.040);最高FiO2以晚期组最高(P=0.006).结论 早期早产儿RDS病情轻、开始PS治疗时间早、剂量足,但需氧疗和机械通气时间长;晚期早产儿和足月儿RDS病情危重、开始PS治疗时间晚、剂量不足、需氧疗和机械通气时间长.对晚期早产儿和足月儿RDS治疗应尽早、足量使用PS.

Effect of Pulmonary Surfactant Therapy on Infants with Respiratory Distress Syndrome at Different Gestational Ages

Objective To explore the difference of effect of pulmonary surfactant(PS) therapy on infants with respiratory distress syndrome(RDS)at different gestational ages.Methods Sixty-seven cases of PS-treated RDS infants at gestational age 28-39 weeks and with birth weight 760-3 240 g were recruited.Early group:18 cases of preterm infants at gestational age 28-30 weeks;medium group:28 cases of preterm infants at gestational age 31-33 weeks;late group:21 cases of either preterm infants at gestational age over 34 weeks or full term infants.Severity of RDS while starting PS therapy,the time of starting PS treatment,the initial dose,re-doses,total dose,the duration of oxygen therapy,the maximum inspired oxygen fraction(FiO2) and mechanical ventilation time were compared among these groups.Results The number of mild RDS cases in early and medium group treated with PS were significantly more than that in the late group(Pa<0.05),whereas the number of severe RDS cases in medium and late group treated with PS were significantly more than that in the early group(Pa<0.05).The time of starting PS treatment was later in late group than that in the early group and medium group.The starting dose of PS applied to early group was significantly higher than that in the medium group and late group(P<0.05).There were no difference in re-dose and total dose among all 3 groups(Pa>0.05).The mechanical ventilation time was longer in the early group and late group(P=0.040);but the maximum FiO2 value was found in the late group(P=0.006).Conclusions Early preterm RDS treated with PS are clinically mild,treated earlier at adequate dosage,and they need longer time on oxygen therapy and mechanical ventilation;which late preterm and full term RDS are more clinically severe,treated with PS later and at inadequate dosage,and they also need longer duration on oxygen therapy and mechanical ventilation.PS shall be used earlier,with adequate dosage in late preterm and full term infants.