2019 年第 1 期 第 14 卷

肺表面活性物质联合布地奈德气管内给药对早产儿支气管肺发育不良的防治效果

Effect of intratracheal administration of pulmonary surfactant plus budesonide on bronchopulmonary dysplasia in premature infants

作者：寇晨韩冬李兆娜武玮刘尊杰张亚南高正平马建荣

英文作者：

单位：100026首都医科大学附属北京妇产医院新生儿重症监护病房

英文单位：

关键词：支气管发育不良；肺表面活性物质；布地奈德；气管内给药；早产儿

英文关键词：

• 摘要：

• 【摘要】目的    探讨肺表面活性物质（PS）联合布地奈德气管内给药对早产儿支气管肺发育不良(BPD)的防治效果。方法    选取2014年8月至2016年12月首都医科大学附属北京妇产医院新生儿重症监护病房(NICU)收治的胎龄＜32周、出生体质量≤1 500 g、出生后即转入NICU并诊断新生儿呼吸窘迫综合征的早产儿86例为研究对象。完全随机分为观察组(40例，PS 100 mg/kg联合布地奈德0.25 mg/kg气管内给药)和对照组(46例,单纯应用PS 100 mg/kg气管内给药)。监测2组患儿血气及炎症因子等指标变化，记录给药频次及呼吸机应用时间，以及纠正胎龄36周时用氧情况。结果    观察组和对照组给药前血氧分压差异无统计学意义（P＞0.05），给药后24、48 h时观察组明显高于对照组［60(56,63)mmHg（1 mmHg=0.133 kPa）比56(53,57)mmHg、60(57,63)mmHg比56(54,58)mmHg］（P＜0.01）。观察组给药前血二氧化碳分压明显低于对照组［58(53,67)mmHg比66(59,71)mmHg］（P＜0.01），给药后8 h起2组血二氧化碳分压均降低，给药后24、48 h时2组间差异无统计学意义［49(45,50)mmHg比 50(46,51)mmHg、48(45,50)mmHg比48(46,50)mmHg］（P＞0.05）。观察组给药频次明显少于对照组，住院治疗期间呼吸机应用时间明显短于对照组［7.00(4.00,8.00)h比8.00(6.75,10.00)h］（P＜0.01）。2组纠正胎龄36周时用氧情况差异无统计学意义（P＞0.05）。观察组患儿出生后2周血清白细胞介素1、6、8水平明显低于对照组［37(25,59)μg/L比61(37,81)μg/L、37(28,57)μg/L比 48(31,90)μg/L、37(28,51)μg/L比50(29,86)μg/L］（P＜0.05）。结论    PS联合布地奈德气管内滴入治疗可以改善早产儿出生后氧合情况，减少给药次数，缩短呼吸机使用时间，抑制炎症因子水平的升高，从而达到防治BPD的效果。

• 【Abstract】Objective    To explore the effect of intratracheal administration of pulmonary surfactant（PS） plus budesonide on bronchopulmonary dysplasia(BPD) in premature infants. Methods    From August 2014 to December 2016, a total of 86 preterm infants with gestational age＜32 weeks, birth weight≤1 500 g, diagnosed of neonatal respiratory distress syndrome and transferred into neonatal intensive care unit(NICU) after birth were enroll in Beijing Obstetrics and Gynecology Hospital, Capital Medical University. They were randomly assigned into PS plus budesonide group（n＝40） and PS-alone group（n＝46）; PS(100 mg/kg) and budesonide(0.25 mg/kg) were administered through intratracheal tube and instillation. Blood gas and inflammatory indicators, drug administration frequency, mechanical ventilation time and oxygenation status at 36-week corrected fetal age were analyzed. Results    There was no statistical difference of oxygen partial pressure between groups before treatment（P＞0.05）; oxygen partial pressure at 24, 48 h after treatment in PS plus budesonide group was significantly higher than that in PS-alone group［60(56,63)mmHg vs 56(53,57)mmHg; 60(57,63)mmHg vs 56(54,58)mmHg］（P＜0.01）. Before treatment, carbon dioxide partial pressure in PS plus budesonide group was significantly lower than that in PS-alone group［58(53,67)mmHg vs 66(59,71)mmHg］（P＜0.01） and it gradually decreased at 8, 24, 48 h after treatment. At 24, 48 h after treatment, carbon dioxide partial pressure showed no significant difference between groups［49(45,50)mmHg vs 50(46,51)mmHg, 48(45,50)mmHg vs 48(46,50)mmHg］（P＞0.05）. The frequency of drug administration and the time of ventilator application［7.00(4.00,8.00)h vs 8.00(6.75,10.00)h］in PS plus budesonide group were significantly less/shorter than those in PS-alone group（P＜0.01）. There was no significant difference of oxygenation status at 36-week corrected fetal age between groups（P＞0.05）. At 2 weeks after birth, levels of serum interleukin-1, -6, -8 in PS plus budesonide group were significantly lower than those in PS-alone group［37(25,59)μg/L vs 61(37,81)μg/L; 37(28,57)μg/L vs 48(31,90)μg/L; 37(28,51)μg/L vs 50(29,86)μg/L］（P＜0.05）. Conclusion    Intratracheal administration of PS combined with budesonide can improve the oxygenation status of preterm infants, reduce the frequency of administration, shorten the application time of ventilator and inhibit the increase of inflammatory proteins, which can prevent the occurrence of BPD.