肺表面活性物质治疗早产儿呼吸窘迫综合征

目的探讨肺表面活性物质(PS)治疗早产儿呼吸窘迫综合征(RDS)是否能改善其临床经过、降低病死率.方法诊断为RDS且胸片在Ⅱ级或Ⅱ级以上的早产儿27例,按时间顺序分组,1997年11月～1998年10月14例作为对照组,给以机械通气;1998年11月～1999年12月13例作为治疗组,气管内滴注PS,每次100 mg/kg,必要时6～12 h后按原剂量重复给药,同时给予机械通气.分别在治疗前后测定动脉氧分压(PaO2)、吸入氧浓度(FiO2)、平均气道压(MAP)、拍胸片.结果治疗组于治疗后30 min、6 h、24 h,PaO2显著高于对照组,FiO2、MAP显著低于对照组;胸片除2例重复给药者外,其余11例均于6 h后症状即见改善,24 h明显改善;存活者机械通气时间短,患儿出生0～3 d的死亡率下降,与对照组比较差异有显著性.结论PS治疗早产儿RDS可以迅速提高PaO2,降低呼吸机参数,减少应用呼吸机时间,降低出生0～3d的病死率.

Pulmonary surfactant therapy in premature infants with respiratory distress syndrome

Objective To explore the possibility of improving clinical practice and reducing death rate by applying pulmonary surfactant (PS) in premature infants with respiratory distress syndrome (RDS). Methods 27 cases of premature infants with RDS with chest radiographs at level II or above were divided into two groups by time order: the control group consisted of 14 cases admitted during November 1997 to October 1998,and were given mechanical ventilation ; the treatment group consisted of 13 cases admitted during November 1998 to October 1999, and were given instillation of PS into the trachea (100 mg/kg each time, another dose 6-12 hours later if necessary) and mechanical ventilation. Alveolar PO2 (PaO2), fraction of inspired oxygen (FiO2), and mean airway pressure (MAP) were measured, and chest radiographs were taken, for each patient before and after treatment. Results The PaO2 of the treatment group was significantly higher than that of the control group at 30 minutes, 6 hours, and 24 hours after treatment, while FiO2 and MAP were lower. Compared with the control group chest radiographs for the treatment group (2 cases were excluded due to repeated PS administration) showed somewhat improvement after 6 hours, but remarkable improvement after 24 hours; the survivors had shorter period of mechanica ventilation; and the 0-3 day mortality was lower (64. 3 % vs. 38. 5 %). Conclusion PS therapy in premature infants with RDS seems to increase PaO2 rapidly, lower the parameters of assisted ventilation, shorten the course of assisted ventilation, and reduce the 0-3 day's mortality.