经细管肺表面活性物质注入技术联合布地奈德对支气管肺发育不良新生儿炎症因子和不良反应的影响

Effects of less invasive surfactant administration combined with budesonide on inflammatory markers and adverse reactions in neonates with bronchopulmonary dysplasia

摘要:

目的 探讨经细管肺表面活性物质注入技术（LISA）与布地奈德联合治疗对支气管肺发育不良（BPD）新生儿炎症因子和不良反应的影响。方法 选取2021年1月—2023年1月在常州市妇幼保健院接受治疗的108例BPD新生儿，并通过随机数字表法分为对照组和观察组，每组54例。对照组给予传统气管插管法注入肺表面活性物质与布地奈德混合液，观察组则采用LISA注入混合液。对比两组患儿治疗前和用药24 h后的血气指标［pH、二氧化碳分压（PaCO₂）、氧分压（PaO₂）］、炎症因子水平［肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）］、应激指标［皮质醇（Cor）、促肾上腺皮质激素（ACTH）］、BPD等级，并对比两组无创通气时间、氧气依赖总时间、住院时间、置管失败率、治疗期间的不良反应发生率。结果 观察组患儿治疗后pH、PaO₂、PaCO₂、TNF-α、IL-6、IL-8、Cor、ACTH的差值均高于对照组（P <0.05）。观察组BPD中重度占比、无创通气时间、氧气依赖总时间、住院时间、置管失败率和总不良反应发生率均低于对照组（P <0.05）。结论 LISA联合布地奈德治疗新生儿BPD有助于提升疗效，并可降低患儿应激和不良反应。

Abstract:

Objective To explore the effects of Less Invasive Surfactant Administration (LISA) combined with budesonide on inflammatory markers and adverse reactions in neonates with Bronchopulmonary Dysplasia (BPD).Methods A total of 108 neonates with BPD treated at the Changzhou Maternity and Child Health Care Hospital from January 2021 to January 2023 were enrolled and randomly divided into a control group and an observation group, with 54 cases in each. The control group received a mixture of surfactant and budesonide via traditional endotracheal intubation, while the observation group received the same mixture via LISA. Blood gas indices (pH, partial pressure of carbon dioxide [PaCO₂], and partial pressure of oxygen [PaO₂]), levels of inflammatory markers (tumor necrosis factor-α [TNF-α], interleukin-6 [IL-6], and interleukin-8 [IL-8]), and stress indicators (cortisol [Cor] and adrenocorticotropic hormone [ACTH]) were measured before treatment and 24 hours after medication administration. The BPD grade, duration of non-invasive ventilation, total duration of oxygen dependence, length of hospital stay, catheterization failure rate, and incidence of adverse reactions during treatment were also compared between the two groups.Results The differences in pH, PaO₂, PaCO₂, inflammatory factor levels and stress index levels in the observation group were higher than those in the control group (P < 0.05). The proportion of moderate to severe BPD, the duration of non-invasive ventilation, the total time of oxygen dependence, the length of hospital stay, the failure rate of catheterization and the incidence of adverse reactions were lower than those in the control group (P < 0.05).Conclusion The use of LISA technique combined with budesonide in the treatment of neonatal BPD can enhance therapeutic outcomes and reduce stress and adverse reactions in affected infants.