通讯作者: 何源, Heyuan_xgxse@163.com

DOI：10.12201/bmr.202410.00018

Observation of the therapeutic effect of less invasive surfactant administration on respiratory distress syndrome in extremely premature infants

• 摘要：目的 观察微创法（less invasive surfactant administration，LISA）给药在极早产儿呼吸窘迫综合征的临床疗效及安全性。方法 选择2021年1月至2023年12月孝感市中心医院新生儿科收治，胎龄28+0~31+6周诊断呼吸窘迫综合征早产儿进行前瞻性研究，随机分为LISA组和气管插管-注入肺表面活性物质-拔管（Intubation, administration of Surfactant, Extubation, InSurE）组，比较两组给药过程中不良事件发生率，给药前后血气分析、经皮血氧饱和度(pulse oxygen saturation,SPO2)、血压的变化情况以及临床疗效、并发症及转归。结果 共纳入65例，LISA组33例，InSurE组32例。两组操作过程中，药物反流、心动过缓、呼吸暂停或SPO2＜80%发生率无统计学差异(P>0.05)；LISA组SPO2低于InSurE组，第2、4分钟血压监测低于InSurE组，差异均有统计学意义(P<0.05)。LISA组治疗后1h的PaO2高于InSurE组，PaCO2低于InSurE组，差异均有统计学意义(P<0.05)。 LISA组72h内机械通气比例及氧疗时间方面均低于InSurE组、差异均有统计学意义(P<0.05)；两组PS再利用率、NCPAP治疗时间、住院时间比较差异无统计学意义，(P>0.05)。LISA组3-4级脑室旁-脑室内出血发生率低于InSurE组、差异具有统计学意义(P<0.05)；两组其他并发症发生率差异均无统计学意义(P>0.05)。结论 微创法给予PS治疗极早产儿RDS能够减少机械通气发生率、缩短氧疗时间、减少严重PIVH的发生。

  关键词： 呼吸窘迫综合征; 新生儿; 极早产儿; 肺表面活性物质; LISA技术; InSurE技术

   

  Abstract: Objective: To observe the clinical efficacy and safety of less invasive surfactant administration (LISA) in the treatment of respiratory distress syndrome in extremely premature infants. Method: A prospective study was conducted on premature infants diagnosed with RDS admitted to the neonatal intensive care unit of Xiaogan Central Hospital from January 2021 to December 2023, with gestational age of 28+0~31+6W. They were randomly divided into the LISA group and the intubation administration of surfactant extubation (InSurE) group. The incidence of adverse events, blood gas analysis before and after administration, pulse oxygen saturation (SPO2), changes in blood pressure, clinical efficacy, complications, and outcomes were compared between the two groups.Result: A total of 65 cases were included, with 33 cases in the LISA group and 32 cases in the InSurE group. There was no statistically significant difference in the incidence of drug reflux, bradycardia, apnea, or SPO2<80% between the two groups of operations (P>0.05); During the operation, the SPO2 of the LISA group was lower than that of the InSurE group, and the blood pressure monitoring at the 2nd and 4th minutes was lower than that of the InSurE group at the corresponding time points, with statistically significant differences (P<0.05). After 1 hour of treatment, the PaO2 in the LISA group was higher than that in the InSurE group, and the PaCO2 was lower than that in the InSurE group, with statistically significant differences (P<0.05). The mechanical ventilation ratio and oxygen therapy time within 72 hours in the LISA group were lower than those in the InSurE group, and the differences were statistically significant (P<0.05); There was no statistically significant difference in the reuse rate of PS, NCPAP treatment time, and hospitalization time between the two groups (P>0.05). The incidence of grade 3-4 intraventricular hemorrhage in the LISA group was lower than that in the InSurE group, and the difference was statistically significant (P<0.05); There was no statistically significant difference in the incidence of other complications between the two groups (P>0.05). Conclusion: Less invasive PS treatment for extremely premature infants with RDS can reduce the incidence of mechanical ventilation, shorten oxygen therapy time, and reduce the occurrence of severe PIVH.

  Key words: Respiratory distress syndrome; Extremely premature infants; pulmonary surfactant; LISA; InSurE; 

  提交时间：2024-10-08

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• 序号	提交日期	编号	操作
  1	2024-09-13	bmr.202410.00018V1	下载

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