微创肺表面活性物质给药对新生儿呼吸窘迫综合征患儿血气指标及hs-CRP、PCT水平的影响

Effect of less invasive surfactant administration on blood gas parameters and levels of hs-CRP and PCT in neonates with respiratory distress syndrome

摘要:

目的 探讨微创肺表面活性物质给药（LISA）联合经鼻持续气道正压通气（nCPAP）对新生儿呼吸窘迫综合征（NRDS）患儿血气指标及超敏C反应蛋白（hs-CRP）、降钙素原（PCT）水平的影响。方法 回顾性分析2022年1月—2025年12月皖南医科大学第一附属医院（皖南医科大学弋矶山医院）收治的95例NRDS患儿的临床资料，根据肺表面活性物质（PS）给药方式分为LISA组（55例，LISA+nCPAP治疗），传统气管插管-气囊加压PS给药-拔管连接nCPAP（INSURE）组（40例）。比较两组给药前（T₀）、给药后1 h（T₁）、给药后6 h（T₂）、给药后24 h（T₃）时动脉血氧分压（PaO₂）和二氧化碳分压（PaCO₂），T₀、T₃、给药后72 h（T₄）时hs-CRP、PCT水平。比较两组临床结局、并发症发生情况。结果 LISA组与INSURE组T₀、T₁、T₂、T₃时PaO₂、PaCO₂水平比较，结果 ①不同时间点PaO₂、PaCO₂水平比较，差异均有统计学意义（P <0.05）；②LISA组与INSURE组PaO₂、PaCO₂水平比较，差异均有统计学意义（P <0.05），LISA组PaO₂水平较高，PaCO₂水平较低；③LISA组与INSURE组PaO₂、PaCO₂水平变化趋势比较，差异均有统计学意义（P <0.05）。LISA组与INSURE组T₀、T₃、T₄时hs-CRP、PCT水平比较，结果 ①不同时间点hs-CRP、PCT水平比较，差异有统计学意义（P <0.05）；②LISA组与INSURE组hs-CRP、PCT水平比较，差异均有统计学意义（P <0.05），LISA组hs-CRP、PCT水平较低；③LISA组与INSURE组的hs-CRP、PCT水平变化趋势比较，差异有统计学意义（P <0.05）。LISA组用氧时间、住院时间短于INSURE组，再次机械通气、并发症总发生率低于INSURE组（P <0.05）。结论 LISA技术可有效改善患儿血气指标，降低hs-CRP、PCT水平，从而降低需再次机械通气率与并发症发生率，改善临床结局。

Abstract:

Objective To explore the effects of less invasive surfactant administration (LISA) combined with nasal continuous positive airway pressure (nCPAP) on blood gas parameters and levels of high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) in neonates with respiratory distress syndrome (NRDS).Methods A retrospective analysis was conducted on the clinical data of 95 NRDS infants admitted to The First Affiliated Hospital of Wannan Medical University from January 2022 to December 2025. Based on the method of pulmonary surfactant (PS) administration, the patients were divided into the LISA group (n = 55 cases, treated with LISA + nCPAP) and the intubation-surfactant-extubation (INSURE) group (n = 40). Arterial partial pressure of oxygen (PaO₂) and carbon dioxide (PaCO₂) were measured before treatment (T₀) and at 1 h (T₁), 6 h (T₂), and 24 h (T₃) after administration. Serum levels of hs-CRP and PCT were assessed at T₀, T₃, and 72 h after administration (T₄). Clinical outcomes and the incidence of complications were also compared between the two groups.Results PaO₂ and PaCO₂ levels at T₀, T₁, T₂, and T₃ were analyzed using repeated-measures analysis of variance (ANOVA). The results showed that significant differences were observed across time points (F = 165.324 and 212.542, respectively; both P = 0.000) and between the two groups (F = 12.455 and 18.676, respectively; both P = 0.000), with higher PaO₂ and lower PaCO₂ in the LISA group than in the INSURE group. Significant differences were observed in the change trends of PaO₂ and PaCO₂ levels between the two groups (F = 6.783 and 9.451, respectively; both P = 0.000). Hs-CRP and PCT levels at T₀, T₃, and T₄ were also analyzed using repeated-measures ANOVA. The results showed that significant differences were observed across time points (F = 105.324 and 223.185, respectively; both P = 0.000) and between the two groups (F = 7.524 and 11.243, respectively; P = 0.007 and 0.001), with lower hs-CRP and PCT levels in the LISA group. Significant differences were observed in the change trends of hs-CRP and PCT levels between the two groups (F = 4.896 and 8.452, respectively; P = 0.008 and 0.000). The duration of oxygen therapy and length of hospital stay were shorter in the LISA group than in the INSURE group (P < 0.05). In addition, the rates of recurrent need for mechanical ventilation and total complications were lower in the LISA group (P < 0.05).Conclusion LISA effectively improves blood gas parameters in pediatric patients and reduces hs-CRP and PCT levels, thereby lowering the incidence of recurrent need for mechanical ventilation and complications, as well as optimizing clinical outcomes.