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目的:探讨国产肺表面活性物质(pulmonary surfactant,PS)治疗早产儿呼吸窘迫综合征(neonatal respiratory distresssyndrome,NRDS)的临床疗效及安全性。方法:对2009年10月～2010年10月出生的70例呼吸窘迫综合征早产儿进行研究。治疗组42例NRDS患儿气管内注入国产PS后机械通气治疗,对照组28例NRDS患儿单纯应用机械通气治疗。比较两组临床表现、血气分析、机械通气参数、肺X线片转归、机械通气及住院时间、并发症及结局等。结果:治疗组患儿临床症状迅速好转。用药后1 h血气PaO2、pH开始明显上升,PaCO2明显下降(P<0.05或P<0.01)。机械通气参数FiO2、PIP于用药后1 h内明显下调,RR和PEEP分别于用药后6 h、48 h明显下降(P<0.05或P<0.01)。应用国产PS后2～6 h治疗组机械通气参数FiO2明显低于对照组(P2h<0.05,P6h<0.05),PIP值于用药后1～72 h内均明显低于对照组(P<0.05或P<0.01)。治疗组用药2～6 h后,肺X线片显示NRDS病变明显改善(P<0.05),对照组未见明显改善(P>0.05)。治疗组机械通气时间、住院时间较对照组短,但差异无统计学意义(P均>0.05),两组并发症等方面比较差异无统计学意义。结论:应用国产肺表面活性物质治疗早产儿呼吸窘迫综合征安全有效。
Objective: To investigate the clinical efficacy and safety of domestic pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS). Methods: Seventy patients with respiratory distress syndrome born from October 2009 to October 2010 were studied. In the treatment group, 42 children with NRDS were given intratracheal instillation of PS after mechanical ventilation, and 28 children with NRDS in the control group were treated with mechanical ventilation alone. The clinical manifestations, blood gas analysis, mechanical ventilation parameters, lung X-ray findings, mechanical ventilation and hospital stay, complication and outcome were compared between the two groups. Results: The clinical symptoms of the treatment group improved rapidly. PaO2 and pH began to increase at 1 h after treatment, and PaCO2 decreased significantly (P <0.05 or P <0.01). Mechanical ventilation parameters FiO2 and PIP were significantly decreased within 1 h after treatment, and RR and PEEP were significantly decreased at 6 and 48 h (P <0.05 or P <0.01), respectively. FiO2 in the treatment group was significantly lower than that in the control group (P2h <0.05, P6h <0.05), PIP was significantly lower than that in the control group (P <0.05 or P <0.05 or P < P <0.01). After 2 to 6 hours of treatment, lung radiographs showed that the NRDS lesion was significantly improved in the treatment group (P <0.05), but no significant improvement in the control group (P> 0.05). The time of mechanical ventilation and hospital stay in the treatment group were shorter than those in the control group, but the difference was not statistically significant (all P> 0.05). There was no significant difference in the complications between the two groups. Conclusion: It is safe and effective to treat respiratory distress syndrome in preterm infants by using domestic pulmonary surfactant.