| 经鼻间歇正压通气下微创肺表面活性物质给药技术联合布地奈德治疗早产儿呼吸窘迫综合征的疗效及安全性研究 |
| 投稿时间：2025-01-09 修订日期：2025-01-12 点此下载全文 |
| 引用本文：涂雪丽,金宝,陈雪琦,吴杰斌,张心,雷红林,周彬.经鼻间歇正压通气下微创肺表面活性物质给药技术联合布地奈德治疗早产儿呼吸窘迫综合征的疗效及安全性研究[J].医学研究杂志,2025,54(6):121-126 |
| DOI：
10.11969/j.issn.1673-548X.2025.06.022 |
| 摘要点击次数: 18 |
| 全文下载次数: 8 |
|
| 基金项目:江苏省卫生健康委员会科研项目(Z2020060);江苏省徐州市医学领军人才培养项目(XWRCHT20210039) |
|
| 中文摘要:目的 探讨经鼻间歇正压通气(nasal intermittent positive pressure ventilation, NIPPV)下,采用微创肺表面活性物质给药(less invasive surfactant administration,LISA)技术同时注入布地奈德治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效及安全性。方法 采用前瞻性随机对照研究,将2022年2月～2024年3月徐州市中心医院新生儿病房收治的胎龄26～32周的RDS早产儿分为观察组和对照组。对照组暂停经鼻持续气道正压通气(nasal continuous positive airway pressure, NCPAP),采用气管插管-使用肺表面活性物质-拔管(intubation-surfactant-extubation,INSURE)技术给予肺表面活性物质(pulmonary surfactant,PS)后,继续给予NCPAP治疗。观察组在NIPPV支持下,经喉镜气管内置入LISA管,采用LISA技术注入PS和布地奈德混合液。比较两组气管注入PS后1h、6h的血气分析、用药情况、无创呼吸支持时间、总用氧时间、撤机失败率、治疗72h内气管插管率及呼吸暂停次数等临床疗效,以及布地奈德相关并发症和支气管肺发育不良(bronchopulmonary dysplasia, BPD)发生情况。结果 共纳入RDS早产儿126例,其中观察组65例,对照组61例。与对照组比较,观察组注入药物过程中反流发生率低于对照组[10.8%(7/65)vs 24.6%(15/61)],差异有统计学意义(P＜0.05)。观察组气管注入PS后1h、6h的血氧分压(PaO2)/吸入氧气分数(FiO2)(P/F)值高于对照组,PaCO2低于对照组,差异均有统计学意义(P<0.05)。观察组无创呼吸支持时间(11.4 ± 4.6天 vs 15.9 ± 5.6天)、总用氧时间(14.9± 6.9天 vs 21.2±8.5天)、撤机失败率[10.8%(7/65) vs 24.6%(15/61)]、72h气管插管率[9.2%(6/65) vs 23.0%(14/61)]、2次使用PS率[18.5%(12/65) vs 34.4%(21/61)]、呼吸暂停[9.0(3.0～25.0)次 vs 17.0(5.0～29.0)次]均低于对照组,差异有统计学意义(P＜0.05)。观察组BPD的发生率低于对照组[15.4%(10/65) vs 34.4%(21/61)],差异有统计学意义(P<0.05),布地奈德相关并发症发生率差异无统计学意义(P>0.05)。结论 NIPPV支持下,采用LISA技术给予PS和布地奈德,能减少胎龄26～32周RDS早产儿给药过程中的不良反应,在减少无创呼吸支持时间、总用氧时间、气管插管机械通气率和BPD的发生率等方面具有优势。 |
| 中文关键词:LISA技术 布地奈德 无创呼吸支持 新生儿呼吸窘迫综合征 早产 |
| |
| Efficacy and Safety of Less Invasive Surfactant Administration Combined with Budesonide and Supported by Nasal Intermittent Positive Pressure Ventilation in Preterm Infants with Respiratory Distress Syndrome: a Clinical Research. |
|
|
| Abstract:Objective To study the efficacy and safety of less invasive surfactant administration (LISA) combined with budesonide and supported by nasal intermittent positive pressure ventilation (NIPPV) in preterm infants with respiratory distress syndrome (RDS). Methods Premature infants with RDS at the gestational age of 26-32 weeks in the neonatal ward of Xuzhou Central Hospital from February 2022 to March 2024 were divided into the observation group and the control group in this prospective randomized controlled trial. The control group suspended nasal continuous positive airway pressure (NCPAP), they were intubated and infused with PS into the lung through endotracheal tube and extubated (INSURE), then continued to receive NCPAP. In the observation group, a LISA tube was inserted through the vocal cords under direct vision with direct laryngoscope, then infused pulmonary surfactant (PS) and budesonide into the lung when NIPPV ventilation was applied. The results of blood gas analysis at 1h and 6h after intratracheal instillation of PS, medication administration, clinical efficacy, related complications of budesonide, bronchopulmonary dysplasia (BPD) were compared between the two groups. Results A total of 126 preterm infants with RDS were enrolled in the study, including 65 in the observation group and 61 in the control group. The incidence of regurgitation in the observation group were lower than those in the control group [(10.8% (7/65) vs 24.6% (15/61)], and the differences were statistically significant (P<0.05). The PaO2/FiO2 (P/F) in the observation group at 1h and 6h were higher than those in the control group, while PaCO2were lower than those in the control group, and the differences were statistically significant (all P＜0.05). The duration of non-invasive respiratory support (11.4±4.6 days vs 15.9±5.6 days), total oxygen inhaling (14.9±6.9 days vs 21.2±8.5 days), failure rate of machine withdrawal[(10.8% (7/65) vs 24.6% (15/61)], the rate of tracheal intubation within 72h[9.2% (6/65) vs 23.0% (14/61)], and re-administration of PS[18.5% (12/65) vs 34.4% (21/61)], the times of apnea [9.0(3.0-25.0) times vs 17.0(5.0-29.0) times] in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05).The occurrence of BPD in the observational group were lower than those in the control group[15.4% (10/65) vs 34.4% (21/61)](P<0.05). There were no significant differences between two groups in the related complications of budesonide (all P>0.05). Conclusion LISA combined with budesonide and supported by NIPPV can effectively improve oxygenation, shorten the duration of non-invasive respiratory support, reduce the mechanical ventilation rate, and reduce the incidence of BPD in the treatment of premature infants with RDS at the gestational age of 26-32 weeks. |
| keywords:Less invasive surfactant administration Budesonide Non-invasive respiratory support Newborn respiratory distress syndrome Preterm |
| 查看全文 查看/发表评论 下载PDF阅读器 |
|
|
|
