摘要
目的探讨应用肺表面活性物质(pulmonary surfactant,PS)制剂——牛肺表面活性物质(calf pulmonary surfactant,CPS,商品名:珂立苏)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)时有效减少肺出血发生率的最终应用时限。方法收集2008年5月至2009年6月国内22家各级医院新生儿病房应用PS治疗NRDS的相关临床资料。NRDS患儿分为3组,第1组:重度NRDS采用常规机械通气(CMV)+CPS治疗;第2组:轻度NRDS采用CMV+CPS治疗;第3组:轻度NRDS采用鼻塞式持续气道正压通气(nCPAP)+CPS治疗;将生后1、2、3、4、5、6、7、8 h作为时间界点,逐一比较在界点前后使用CPS的各组肺出血的发生率,并探讨NRDS严重程度相同的患儿在不同通气模式下肺出血发生率。结果对于重度NRDS患儿,以生后4、5、6、7、8 h作为使用CPS的时间界点时肺出血的发生率比较差异有统计学意义(P<0.05)。对于轻度NRDS患儿,生后5 h内使用组肺出血发生率明显低于5 h后使用组(3.2%vs9.7%,P<0.05)。对于轻度NRDS患儿,以生后5 h为界点,第3组的肺出血发生率明显低于第2组(0.3%vs 6.5%,P<0.05)。结论生后5 h内使用CPS是治疗NRDS时有效降低肺出血发生率的最后时限,对于轻度NRDS,生后5 h内使用CPS联合nCPAP可明显减少肺出血发生率。
Objective Pulmonary hemorrhage （PH） is considered as one of severe adverse events associated with surfactant therapy in the treatment of neonatal respiratory distress syndrome （NRDS）. In this multicenter retrospectively study, we wish to find the timing of initial surfactant administration in order to reduce the incidence of PH. Methods Clinical data of 453 NRDS cases treated by calf pulmonary surfactant （CPS） in the Department of Neonatology out of 22 hospitals during May 2008 to June 2009 were collected and reviewed. These neonates were divided into 3 groups： severe NRDS cases treated by CPS and conventional mechanical ventilation（CMV） （group 1）, mild NRDS cases treated with CPS and CMV （group 2）, and mild RDS cases treated with CPS and nasal continuous positive airway pressure （nCPAP） （group 3）. Postnatal hours 1, 2, 3, 4, 5, 6, 7 and 8 were selected as cutoff times, and the incidence of PH at these time points were analyzed. The incidence of PH between group 2 and 3 were also compared. Results For severe NRDS cases, significant differences in the incidence of PH were found when postnatal hours 4, 5, 6, 7 and 8 were selected as the cutoff time （P〈0.05）. For mild NRDS cases, the incidence of PH was significantly lower in the neonates receiving CPS within 5 h after birth than those beyond 5 h （3.2% vs 9.7%, P〈0.05）. Postnatal hour 5 was selected as the cutoff time for mild NRDS cases, with the incidence of PH obviously lower found in the neonates treated by nCPAP than those by CMV （0.3% vs 6.5%, P〈0.05）. Conclusion Postnatal hour 5 is identified as the timing of initial CPS administration to reduce the incidence of PH. For mild NRDS, the incidence of PH is greatly decreased when initial surfactant administration performed within 5 h after birth followed by nCPAP.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2014年第11期1203-1207,共5页
Journal of Third Military Medical University
关键词
新生儿呼吸窘迫综合征
肺出血
肺表面活性物质
多中心研究
neonatal respiratory distress syndrome
pulmonary hemorrhage
pulmonary surfactant
multi-center study
