经胃管微创注入肺表面活性物质技术治疗新生儿呼吸窘迫综合征的效果

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摘要目的探讨经胃管微创注入肺表面活性物质技术在治疗新生儿呼吸窘迫综合征中的效果。方法选择2017年5月～2018年5月湖北省妇幼保健院新生儿重症监护室（NICU）收治的胎龄26～34周诊断为呼吸窘迫综合征（RDS）的早产儿40例。按照随机数字表法进行分组，即经胃管微创注入肺表面活性物质（LISA组，20例）和气管插管-肺表面活性物质-拔管（INSURE组，20例），LISA组在经鼻持续气道正压通气（NCPAP）下经直接喉镜直视下向气管内置入5F胃管并缓慢注入肺表面活性物质（PS），INSURE组采用气管插管注入PS，拔管后行NCPAP，观察两组患儿治疗后的呼吸机参数需求的变化情况以及不良反应和并发症的发生率。结果 LISA组患儿的血氧饱和度（SpO2）下降1例、心动过缓1例、呼吸暂停0例、生后72 h内机械通气1例，明显低于INSURE组的SpO2下降9例、心动过缓8例、呼吸暂停8例、生后72 h内机械通气7例；LISA组6 h后氧浓度下降比例为19%，高于INSURE组的13%，差异有统计学意义（P ＜ 0.05）。两组的再次使用PS、死亡率、气漏、支气管肺发育不良、坏死性小肠结肠炎、早产儿视网膜病、颅内出血等疾病发生率比较，差异无统计学意义（P ＞ 0.05）。结论 LISA是治疗RDS的一种安全有效的给药方法。

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	张佩夏世文祝华平彭斯聪

关键词 ：肺表面活性物质, INSURE技术, 微创肺表面活性物质给药, 呼吸窘迫综合征, 新生儿

Abstract：Objective To investigate the effect of minimally invasive injection of pulmonary surfactant through gastric tube in the treatment of neonatal respiratory distress syndrome. Methods Forty preterm infants with respiratory distress syndrome (RDS) diagnosed by neonatal intensive care unit (NICU) in Hubei Maternal and Child Health Hospital from May 2017 to May 2018. According to the random number table method, they were divided into two groups, namely, minimally invasive injection of pulmonary surfactant through gastric tube (LISA group, 20 cases) and tracheal intubation-pulmonary surfactant-extubation (INSURE group, 20 cases). In LISA group, 5F gastric tube was inserted into trachea under direct laryngoscope and pulmonary surfactant (PS) was slowly injected into trachea under nasal continuous positive airway pressure (NCPAP). In INSURE group, PS was injected through tracheal intubation and NCPAP was performed after extubation. The changes of ventilator parameters, adverse reactions incidence of and complications after treatment were observed. Results In LISA group, the decrease of oxygen saturation (SpO2) in 1 case, bradycardia in 1 case, apnea in 0 cases and mechanical ventilation in 72 hours after birth were significantly lower than those in INSURE group SpO2 in 9 cases, bradycardia in 8 cases, apnea in 7 cases; in LISA group, the decrease of oxygen concentration in 6 hours was 19%, higher than that in INSURE group (13%), with significant difference (P ＜ 0.05). There was no significant difference in the incidence of re-use of PS, mortality, air leakage, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of premature infants, intracranial hemorrhage between the two groups (P ＞ 0.05). Conclusion LISA is a safe and effective method for the treatment of RDS.

Key words： Lung surface active substances Tracheal intubation-pulmonary surfactant-extubation technology Minimally invasive pulmonary surfactant administration Respiratory distress syndrome Neonatal

基金资助:湖北省科技厅公益性科技研究项目（2012DCA1 2005）。

作者简介: 张佩（1986-），女，硕士；研究方向：新生儿疾病。

引用本文:

张佩夏世文祝华平彭斯聪. 经胃管微创注入肺表面活性物质技术治疗新生儿呼吸窘迫综合征的效果[J]. 中国医药导报, 2020, 17(6): 95-98,114.
ZHANG Pei XIA Shiwen ZHU Huaping PENG Sicong. Effect of minimally invasive injection of pulmonary surfactant through gastric tube in the treatment of neonatal respiratory distress syndrome. 中国医药导报, 2020, 17(6): 95-98,114.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I6/95

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