早期或晚期抢救性给予肺表面活性物质对呼吸窘迫综合征早产儿的影响

摘要

目的 观察早期或晚期抢救性给予肺表面活性物质(PS)对呼吸窘迫综合征(RDS)早产儿的影响.方法 回顾性分析99例需要机械通气的RDS患儿的临床资料.按照PS的给予时间分为早期组(出生2 h内)48例和晚期组(出生2～12 h)51例,观察2组在机械通气时间、氧疗时间、病死率以及并发症:气漏(肺间质气肿、气胸)、肺出血、支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)、PDA、严重脑室内出血(IVH)的发生率方面的变化.结果 早期组和晚期组机械通气时间[(4.14±1.88) d vs (5.84±3.36) d]比较有统计学差异(P＜0.05).2组氧疗时间[(5.84±3.36) d vs (8.05±5.48) d]比较差异有统计学意义(P＜0.05).28 d内早产儿的病死率:早期组为6.25%、晚期组为5.88%,出生12 h内不同时间给予PS对病死率无影响(OR=1.07,95% CI 0.21～5.56,P=1.00).早期组BPD的发生率8.7%,低于晚期组16.0%,但无统计学差异(OR=0.49,95%CI 0.13～1.74,P=0.36).其他并发症如气漏、肺出血、PDA、NEC、严重IVH发生率,2组患儿之间均无明显差异(Pa＞0.05).结论 早期抢救性给予PS能显著减少RDS早产儿的机械通气时间和氧疗时间,降低BPD的发生率.%Objective To compare the effects of early versus delayed selective surfactant therapy for neonatal respiratory distress syndrome(NRDS). Methods A retrospective analysis was performed on 99 preterm infants with NRDS. These infants were divided into two groups according to the time of surfactant given:the early group (n = 48 ) with selective surfactant administration within the first 2 hours of life and the delayed group (n = 51 ) with selective surfactant administration within 2 - 12 hours after birth. To observe the differences in the duration of mechanical ventilation, duration of oxygen therapy, mortality of preterm infants and the incidence of air leak syndromes( pulmonary interstitial emphysema, pneumothorax ), pulmonary hemorrhage, bronchopulmonary dysplasia ( BPD ), necrotizing enterocolitis ( NEC ), patent ductus arteriosus(PDA) ,severe intraventricular hemorrhage (IVH)between the 2 groups. Results Early selective surfactant administration significantly decreased duration of mechanical ventilation[ (4.14 ± 1.88 ) d vs ( 5.84 ± 3.36 ) d ,P ＜ 0.05 ]. There was also significant difference in duration of oxygen therapy [ ( 5.84 ± 3.36 ) d vs ( 8.05 ± 5.48 ) d ] between the 2 groups( P ＜ 0.05 ). The mortality of preterm infants within 28 d after birth were 6.25％ in the early group and 5.88％ in the delayed group. There was no significant difference in mortality ( OR = 1.07,95 ％ CI 0. 21 - 5.56, P = 1.00). The incidence of BPD in early group ( 8.7％ ) was lower than that in delayed group ( 16.0％ ),but didn't show significant difference( OR =0.49,95％ CI 0. 13 - 1.74,P =0.36). There were no significant differences in the incidence of air leak syndromes,pulmonary hemorrhage,PDA, NEC, severe IVH between the 2 groups( Pa ＞ 0. 05 ). Conclusions Earlyselective surfactant administration given to preterm infants with NRDS requiring mechanical ventilation leads to significantly decrease duration of mechanical ventilation and duration of oxygen therapy,and the incidence of BPD was decreased compared with delayed treatment.