LISA技术和INSURE技术治疗早产儿呼吸窘迫综合征的疗效分析

宋飞飞; 张兰

doi:10.16766/j.cnki.issn.1674-4152.002051

LISA技术和INSURE技术治疗早产儿呼吸窘迫综合征的疗效分析

doi: 10.16766/j.cnki.issn.1674-4152.002051

宋飞飞,
张兰^,

安徽医科大学附属省立医院儿科，安徽合肥 230001

基金项目:

国家卫生健康委员会医药卫生科技发展项目 WA2020HK60

详细信息

通讯作者:
张兰, E-mail: zhanglan1978@ustc.edu.cn

中图分类号: R722 R720.5
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出版历程
- 收稿日期: 2021-03-11
- 网络出版日期: 2022-02-16

Comparison of LISA technique and INSURE technique in the treatment of respiratory distress syndrome in premature infants

SONG Fei-fei,
ZHANG Lan^,

Department of Pediatrics, Anhui Provincial Hospital, Anhui Medical University, Hefei, Anhui 230001, China

摘要

摘要: 目的探讨微创肺表面活性物质给药(less invasive surfactant administration，LISA)技术相较于插管-肺表面活性物质给药-拔管(intubate-surfactant-extubate, INSURE)技术在早产儿呼吸窘迫综合征(respiratory distress syndrome，RDS)中的应用疗效及对早产儿住院期间并发症的影响。方法选取2019年8月—2020年4月期间安徽省8所新生儿重症监护病房(NICU)收治的20例符合入组条件的患儿作为微创肺表面活性物质给药组(LISA组)，采用LISA技术完成肺泡表面活性物质(PS)给药。另选取自2017年1月—2020年1月期间在安徽省立医院收治的36例患儿作为INSURE组，采用INSURE技术完成PS给药。收集并比较2组患儿及母亲的基本信息、给药前后的动脉血气值、给药时的副反应及住院期间的并发症和用氧情况。结果 LISA组给药后的pH值较给药前升高(P＜0.001)，给药后的PaCO₂值较给药前降低(P=0.005)，但给药前后PaO₂差异无统计学意义；INSURE组患儿在给药前后的pH值、PaCO₂值及PaO₂值均无明显改变。LISA组在给药24内的pH值在正常范围内的例数较INSURE组多[38.89%(7/18)vs. 23.33%(7/30)，P=0.009]；在给药过程中血氧饱和度下降情况2组差异有统计学意义[0(0.00%)vs. 3(15.00%)，P=0.041]；2组支气管肺发育不良(BPD)的发生率、无创失败率及无创辅助通气时间差异无统计学意义(均P>0.05)。结论 LISA技术可以在有自主呼吸的患儿中进行，可明显改善肺泡通气，且不会增加并发症的发生率。
- 微创肺表面活性物质给药技术 /
- 插管-肺表面活性物质给药-拔管技术 /
- 新生儿呼吸窘迫综合征 /
- 支气管肺发育不良
Abstract: Objective To compare the outcomes and side effects between the less invasive surfactant administration (LISA) and the intubate surfactant extubate (INSURE) method in premature infants with respiratory distress syndrome. Methods In the experimental group, 20 children who met the inclusion criteria were recruited from eight neonatal intensive care units in Anhui Province from August 2019 to April 2020 to complete pulmonary surfactant (PS) administration by LISA technology. In the control group, 36 children were recruited from Anhui Provincial Hospital from January 2017 to January 2020 to complete PS administration by INSURE technology. The basic information of children and mothers, arterial blood gas values before and after administration, oxygen saturation and heart rate during administration, complications and oxygen use during hospitalisation were collected and compered. Results The pH value of the LISA group after administration was significantly higher than that before administration (P < 0.001). The PCO₂ value in the LISA group after administration was significantly lower than that before administration (P=0.005). The PO₂ changes in the LISA group before and after administration were not statistically significant. The pH, PCO₂ and PO₂ values of the INSURE group showed no significant changes before and after administration. The LISA group tended to have a normal pH range compared with the INSURE group (P=0.009). The decrease of blood oxygen saturation during the administration was statistically significant between the two groups (P=0.041). No statistically significant difference was observed in the incidence of bronchopulmonary dysplasia (BPD), noninvasive failure rate and time of noninvasive ventilation between the two groups. Conclusion LISA technology can be performed in infants with spontaneous breathing, and it can significantly improve alveolar ventilation without increasing the incidence of complications such as BPD.
- Less invasive surfactant administration /
- Bronchopulmonary dysplasia /
- Neonatal respiratory distress syndrome /
- Intubate surfactant extubate

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表 1 2组呼吸窘迫综合征早产儿基本资料比较

组别	例数	性别[例(%)]		胎龄(x ±s，周)	出生体重(x ±s，g)	多胎[例(%)]	试管婴儿[例(%)]	Apgar评分≤3分[例(%)]	孕母年龄(x ±s，岁)	孕母妊娠期糖尿病[例(%)]	孕母产前激素[例(%)]
组别	例数	男性	女性	胎龄(x ±s，周)	出生体重(x ±s，g)	多胎[例(%)]	试管婴儿[例(%)]	Apgar评分≤3分[例(%)]	孕母年龄(x ±s，岁)	孕母妊娠期糖尿病[例(%)]	孕母产前激素[例(%)]
INSURE组	36	18(50.00)	18(50.00)	29.17±0.54	1280±198	6(16.67)	3(8.33)	3(8.33)	31.83±5.06	6(16.67)	27(75.00)
LISA组	20	10(50.00)	10(50.00)	29.13±0.57	1254±193	0(0.00)	0(0.00)	1(5.00)	30.20±4.41	5(25.00)	14(70.00)
统计量				0.279^a	0.462^a			0.006^c	1.209^a	0.566^c	0.164^c
P值				0.781	0.646	0.078^b	0.545^b	0.938	0.232	0.452	0.686
注：^a为t值，^b为采用Fisher精确检验，^c为χ²值。

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表 2 2组早产儿给药后的血气分析正常情况比较 [例(%)]

分组	例数	pH	PaCO₂	PaO₂
INSURE组	30	7(23.33)	10(33.33)	25(83.33)
LISA组	18	7(38.89)	7(38.89)	16(88.89)
统计量		6.850^a	3.527^a
P值		0.009	0.060	0.696^b
注：^a为χ²值，^b为采用Fisher精确检验。

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表 3 LISA组早产儿给药前后的血气分析值变化(x ±s)

时间	例数	pH	PaCO₂(mm Hg)	PaO₂(mm Hg)
给药前	18	7.26±0.08	50.26±11.03	80.78±36.34
给药后	18	7.40±0.12	40.91±10.59	80.17±33.22
t值		-4.716	2.372	0.057
P值		＜0.001	0.030	0.955

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表 4 INSURE组早产儿给药前后的血气分析值变化(x ±s)

时间	例数	pH	PaCO₂(mm Hg)	PaO₂(mm Hg)
给药前	30	7.26±0.08	48.36±16.07	65.50±17.39
给药后	30	7.29±0.06	45.95±7.02	68.87±20.48
t值		-0.775	0.400	-0.374
P值		0.464	0.701	0.719

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表 5 2组早产儿治疗后各种并发症情况及NIV时间比较

组别	例数	无创失败数[例(%)]	BPD [例(%)]	颅内出血[例(%)]	ROP [例(%)]	NEC [例(%)]	NIV时间(x ±s，d)
INSURE组	36	8(22.22)	17(47.22)	6(16.67)	7(19.44)	1(2.78)	9.03±6.20
LISA组	20	4(20.00)	8(40.00)	5(25.00)	3(15.00)	3(15.00)	11.95±9.52
统计量		0.021^a	0.271^a	0.566^a	0.003^a	1.346^a	-1.390^b
P值		0.884	0.602	0.452	0.959	0.246	0.170
注：^a为χ²值，^b为t值。

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表 6 2组早产儿给药过程中的不良反应比较 [例(%)]

分组	例数	心率下降	SpO₂波动
INSURE组	36	0(0.00)	0(0.00)
LISA组	20	1(5.00)	3(15.00)
P值		0.368	0.041
注：均使用Fisher精确检验。

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