微创肺表面活性物质联合经鼻间歇正压通气 治疗早产儿呼吸窘迫综合征临床研究

Clinical Study of Less Invasive Pulmonary Surfactants Combined with Nasal Intermittent Positive Pressure Ventilation in the Treatment of Respiratory Distress Syndrome in Premature Infants

摘要:

〔摘 要〕 目的：探讨微创肺表面活性物质给药（LISA）联合经鼻间歇正压通气（NIPPV）在治疗早产儿呼吸窘迫综合 征（RDS）中的疗效。 方法：选择 2021 年 9 月至 2022 年 12 月深圳市第二人民医院新生儿科和广西河池市人民医院新生儿 科收治的 28 周≤胎龄≤ 34 周的 RDS 95 例进行前瞻性研究，根据肺表面活性物质（PS）不同给药方法分为气管插管 – 使 用肺表面活性物质 – 拔管（INSURE）＋经鼻持续气道正压通气（NCPAP）组（47 例）和 LISA ＋ NIPPV 组（48 例）。 INSURE ＋ NCPAP 组患儿给予 INSURE 联合 NCPAP 治疗，LISA ＋ NIPPV 组患儿给予 LISA 技术联合 NIPPV 治疗。比较 两组患儿不同给药方式给药期间不良反应及近期并发症发生率等情况。 结果：LISA ＋ NIPPV 组患儿喉头损伤、气漏综合 征及 PS 反流发生率低于 INSURE ＋ NCPAP 组，差异具有统计学意义（P ＜ 0.05）；两组患儿给药过程中经皮血氧饱和度 下降、心动过缓、再次使用 PS 发生率比较，差异无统计学意义（P ＞ 0.05）。LISA ＋ NIPPV 组患儿置管时间、无创通气 时间短于 INSURE ＋ NCPAP 组，差异具有统计学意义（P ＜ 0.05）；而两组患儿出生后首次使用 PS 时间、总用氧时间比 较，差异无统计学意义（P ＞ 0.05）。LISA ＋ NIPPV 组患儿支气管肺发育不良（BPD）发生率低于 INSURE ＋ NCPAP 组， 差异具有统计学意义（P ＜ 0.05）；两组患儿 72 h 内机械通气、肺出血、消化道出血、脑室内出血（IVH）、新生儿坏死 性小肠结肠炎（NEC）及脑室周围白质软化（PVL）发生率比较，差异无统计学意义（P ＞ 0.05）。 结论：早产儿 RDS 治 疗中，与 INSURE 联合 NCPAP 治疗相比，LISA 给药技术更易操作，置管时间更短，可减少喉头损伤、气漏综合征及 PS 反流等不良反应的发生，在 BPD 的发生及无创通气时间上更有优势，故 NIPPV 可作为 RDS 治疗时 NCPAP 的替代方法。

Abstract:

〔Abstract〕 Objective To investigate the efficacy of less invasive surfactant administration (LISA) combined with nasal intermittent positive pressure ventilation (NIPPV) in the treatment of respiratory distress syndrome (RDS) in premature infants. Methods A prospective study was conducted on 95 premature infants with RDS of 28 weeks ≤ gestational age ≤ 34 weeks in the neonatal department of Shenzhen Second People's Hospital and Guangxi Hechi People's Hospital from September 2021 to December 2022. According to the different administration methods of pulmonary surfactants (PS), they were divided into intubation-using pulmonary surfactant-extubation (INSURE) + nasal continuous positive airway pressure (NCPAP) group (47 cases) and LISA+NIPPV group (48 cases). The INSURE+NCPAP group patients were treated with INSURE combined with NCPAP, while the LISA+NIPPV group patients were treated with LISA technology combined with NIPPV. The incidence of adverse reactions and recent complications during the administration of different medication methods between two groups of children were compared. Results The incidences of laryngeal injury, air leakage syndrome, and PS reflux in the LISA+NIPPV group were lower than those in the INSURE+NCPAP group, with statistically significant differences (P < 0.05). There were no statistically significant differences in the incidence of decreased percutaneous oxygen saturation, bradycardia, and reuse of PS between the two groups of children during the administration process (P > 0.05). The intubation time and non-invasive ventilation time of the LISA+NIPPV group were shorter than those of the INSURE+NCPAP group, and the differences were statistically significant (P < 0.05). However, there was no statistically significant difference in the first use of PS and total oxygen use time between the two groups of children after birth (P > 0.05). The incidence of bronchopulmonary dysplasia (BPD) in the LISA+NIPPV group was lower than that in the INSURE+NCPAP group, and the difference was statistically significant (P < 0.05). There were no statistically significant difference between the two groups in terms of mechanical ventilation, pulmonary hemorrhage, gastrointestinal bleeding, intraventricular hemorrhage (IVH), neonatal necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL) within 72 hours. Conclusion In the treatment of RDS in premature infants, compared with INSURE combined with NCPAP, LISA administration technique is easier to operate and catheterization time is shorter, which can reduce the occurrence of laryngeal injury, air leakage syndrome and PS reflux, and has more advantages in the occurrence of BPD and noninvasive ventilation time. Therefore, NIPPV can be used as an alternative to NCPAP in RDS treatment.