微创肺表面活性物质治疗早产儿呼吸窘迫综合征对发育结局的影响

Effect of less invasive surfactant administration on developmental outcomes in premature infants with neonatal respiratory distress syndrome

摘要:

目的 探讨微创肺表面活性物质（LISA）治疗早产儿呼吸窘迫综合征（NRDS）对发育结局的影响。方法 回顾性分析2019年12月—2021年5月阜阳市人民医院收治的67例NRDS患儿的临床资料。将采用LISA治疗的30例患儿作为研究组，采用气管插管-肺表面活性物质-拔管治疗的37例患儿作为对照组，随访至纠正胎龄12个月。统计两组患儿肺表面活性物质（PS）给药过程中不良反应，分析两组通气、吸氧及再次使用PS情况，比较两组治疗前后血气指标的变化，对比两组并发症发生情况，比较两组随访期间体格发育及听力、视觉、神经系统发育情况。结果 对照组与研究组PS给药操作过程中心动过缓、呼吸暂停、经皮血氧饱和度下降、药物反流发生率，72 h内有创机械通气率、总吸氧时间、无创通气时间、再次使用PS率，视网膜病、坏死性小肠结肠炎、脑室内出血、听力损伤、视觉损伤发生率比较，差异均无统计学意义（P >0.05）。研究组支气管肺发育不良发生率低于对照组（P <0.05）。两组治疗前后动脉血氧分压、动脉血二氧化碳分压、动脉血氧分压/吸入气氧浓度的差值比较，差异均无统计学意义（P >0.05）。两组出院时、纠正6个月、纠正12个月体重、头围、身长、宫外生长迟缓（EUGR）发生率比较，差异均无统计学意义（P >0.05）。两组纠正6个月、12个月的EUGR发生率均低于出院时（P <0.05），两组12个月的EUGR发生率均低于纠正6个月（P <0.05）。研究组智力发展指数、精神运动发展指数、发育商优于对照组（P <0.05）。结论 LISA治疗NRDS早产儿是一种安全有效的PS给药方法，可降低支气管肺发育不良发生风险，改善神经系统发育情况。

Abstract:

Objective To investigate the effect of less invasive surfactant administration (LISA) on developmental outcomes in preterm infants with neonatal respiratory distress syndrome (NRDS).Methods The clinical data of 67 children with NRDS admitted to our hospital from December 2019 to May 2021 were retrospectively analyzed. Thirty of them were treated with LISA (referred to as study group), while 37 infants were treated with the Intubation-Surfactant-Extubation (INSURE) procedure (referred to as control group). All were followed up to the gestationally corrected age of 12 months. The incidence of adverse reactions during the administration of pulmonary surfactant (PS) in the two groups was observed. The ventilation, oxygen inhalation and re-administration of PS in the two groups were analyzed. The changes of blood gas indexes in the two groups before and after treatment, the incidence of complications, and the physical development, hearing, vision and nervous system development of infants were compared between the two groups during the follow-up period.Results There was no significant difference in the incidence of bradykinesia, apnea, decrease in transcutaneous oxygen saturation, drug regurgitation, requirement for mechanical ventilation within 72 h, re-administration of PS, retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), hearing loss and vision loss, or the total time of oxygen inhalation and invasive ventilation between the two groups during the treatment (P > 0.05). The incidence of bronchopulmonary dysplasia (BPD) in the study group was lower than that in the control group (P < 0.05). The differences of blood partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), and PaO₂/inhaled oxygen concentration (FiO₂) before and after treatment were comparable between the two groups (P > 0.05). There were statistically significant differences in the incidence of extrauterine growth restriction (EUGR) in terms of the weight, head circumference and height between the two groups at discharge, and at the gestationally corrected age of 6 and 12 months (P < 0.05). The incidence of EUGR at the gestationally corrected age of 6 and 12 months was lower than that at discharge in both groups (P < 0.05), and the incidence of EUGR at the gestationally corrected age of 12 months was even lower than that at the gestationally corrected age of 6 months in both groups (P < 0.05). The mental development index (MDI), psychomotor development index (PDI) and developmental quotient (DQ) of the study group were better than those of the control group (P < 0.05).Conclusions LISA is a safe and effective approach for PS administration to premature infants with NRDS, by reducing the risk of BPD and improving the development of the nervous system.