预防性应用表面活性剂对新生儿呼吸窘迫综合征防治的研究

目的探讨预防性应用肺表面活性剂(PS)对新生儿呼吸窘迫综合征(NRDS)的防治效果。方法选取100例出生体重<1500 g,胎龄<32周,生后0.5 h内高危早产儿。预防应用PS前无呼吸窘迫综合征(RDS)临床及胸片表现。行胃液稳定微泡试验,微泡数<7个/mm2。随机分为预防组及非预防组,各50例。预防组入院后立即给予固尔苏。非预防组在发生RDS后再给予PS治疗。结果与给药前相比,RDS患儿在给药后1 h动脉氧分压(PaO2)、动脉/肺泡氧分压(a/APO2)、pH、动脉氧分压/吸入氧气浓度(PaO2/F iO2)明显上升,而动脉二氧化碳分压(PaCO2)明显下降(86.2mm Hg±8.1 mm Hg、0.30±0.04、7.38±0.06、178±37、37.3 mm Hg±9.8 mm Hg比45.8 mm Hg±10.4 mm Hg、0.12±0.02、7.18±0.09、63±16、53.6 mm Hg±11.1 mm Hg,P均<0.01),给药后6 h胸部X线片表现也明显改善(1.89分±0.34分比3.02分±0.23分,P<0.01)。接受机械通气的患儿在给药后F iO2及平均气道压(MAP)均较用药前明显下降(6.0 cm H2O±0.3 cmH2O比9.0 cm H2O±1.0 cm H2O,P均<0.05)。预防组RDS的发生率较非预防组为低(30%与64%,χ2=6.032,P<0.01)、重症发生率与病死率也明显降低(分别为20%与53%、0%与25%)(χ2=6.741,P=0.01;χ2=4.519,<0.05)。预防组RDS病人的总机械通气时间、需氧时间及住院时间也均明显短于非预防组(3.6 d±1.7 d比5.9 d±3.6 d,t=4.692,P<0.05;8.6 d±5.5 d比14.1 d±6.2 d,t=4.35,P<0.01;20.5 d±10.0 d比32.8 d±17.8 d,t=2.952,P<0.05)。结论PS替代治疗能改善NRDS患儿的肺换气功能。对具有发生NRDS高危儿预防性补充PS可降低RDS发生率、减轻RDS的严重程度及降低死亡率,减少并发症。

Protective and curative effects of prophylactic administration of pulmonary surfactant on neonatal respiratory distress syndrome

OBJECTIVE: To evaluate the protective and curative effects of prophylactic administration of pulmonary surfactant (PS) on neonatal respiratory distress syndrome (NRDS). METHODS: One hundred neonates aged 0.5 h after birth, with the gestational age < 32 w, birth weight < 1500 g, and number of gastric, stable microbubble < or = 7/mm(2) by gastric stable microbubble test (SMT), but without clinical or radiological manifestations of RDS at the admission, were randomly divided into 2 equal groups: prophylactic group (PG), receiving curosurf, a product of PS, immediately after admission; and non-prophylactic group (N-PG), receiving curosurf only after development of RDS. RESULTS: One hour after the administration of PS, the PaO(2), a/APO(2), pH, and PaO(2) of the PG group were 86.2 mm Hg +/- 8.1 mm Hg, 0.30 +/- 0.04, 7.38 +/- 0.06, and 178 +/- 37, all significantly higher than those of the non-PG group (all P < 0.01), and the PaCO(2) of the PG group was 37.3 mm Hg +/- 9.8 mm Hg, significantly lower than that of the non-PG group (53.6 mm Hg +/- 11.1 mm Hg, P < 0.01). In comparison with the level before the administration of PS (0.75 +/- 0.06), the level of FiO(2) of the 47 pediatric patients receiving mechanical ventilation decreased after the administration of curosurf time-dependently, e.g., was 0.50 +/- 0.09, 0.34 +/- 0.06, and 0.25 +/- 0.07 8, 48, and 96 hours after the administration. In comparison with the level before the administration of curosurf 9.0 +/- 1.0 cm H2O, the level of mean airway pressure (MAP) decreased time-dependently after the administration, e.g., were 7.5 +/- 0.8 and 6.0 +/- 0.3 48 and 96 hours after the administration (all P < 0.01). Compared with that before the administration of curosurf (3.02 +/- 0.2), the X-ray chest score decreased time-dependently after the administration of curosurf, e.g., were 1.89 +/- 0.34, 1.82 +/- 0.33, and 1.17 +/- 0.42 6, 12, and 72 hours after the administration (all P < 0.01). The RDS rate of the PG group was 30%, significantly lower than that of the non-PG group (P < 0.01). The severe case rate of the PG group was 20%, significantly lower than that of the N-PG group (53%, P = 0.01). The mortally of the PG group was 0, significantly lower than that of the non-PG group (P < 0.05). The total times of supplemental oxygen administration, assisted ventilation and hospitalization of the 47 patients with RDS in the PG group were significantly shortened compared with the RDS patients in the N-PG group [(3.6 +/- 1.7) d vs. (5.9 +/- 3.6) d, P < 0.05; (8.6 +/- 5.5 d vs. (14.1 +/- 6.2) d, P < 0.01; and (20.5 +/- 10.0) d vs. (32.8 +/- 17.8) d, P < 0.05). CONCLUSION: Prophylactic administration of PS to the preterm neonates with high risk of RDS effectively decreases the incidence of RDS, development of severe cases and mortality, shorten the disease course, the duration of supplemental oxygen administration and assisted ventilation, thus decreasing the potential morbidity associated with long-term oxygen supplement and assisted ventilation.