中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2015年
6期
416-420
,共5页
陈筱青%郭丽敏%李悦%章晔%管亚飞%崔曙东%胡毓华
陳篠青%郭麗敏%李悅%章曄%管亞飛%崔曙東%鬍毓華
진소청%곽려민%리열%장엽%관아비%최서동%호육화
肺表面活性剂%呼吸窘迫综合征%婴儿,早产
肺錶麵活性劑%呼吸窘迫綜閤徵%嬰兒,早產
폐표면활성제%호흡군박종합정%영인,조산
Pulmonary surfactant%Respiratory distress syndrome%Infant,preterm
目的 观察不同剂量肺表面活性剂(珂立苏)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效.方法 研究对象为江苏省4家新生儿重症监护病房内诊断为NRDS、＜2 500 g的早产儿,根据珂立苏首剂量分为高剂量治疗组(69例)和常规剂量治疗组(61例).高剂量组患儿予珂立苏100 mg/kg,常规剂量组予珂立苏70 mg/kg.比较2组患儿氧合指数、机械通气、氧疗时间及相关并发症等情况.结果 2组患儿用药后动脉血氧分压[pa(O2)]迅速改善,高剂量组用药1h、12 h、24 hpa(O2)升至(80.27±36.81) mmHg(1 mmHg=0.133kPa)、(73.03 ±24.94) mmHg、(72.35 ±24.72) mmHg,改善尤为显著,差异均有统计学意义(P均＜0.05).同时点高剂量组pa(O2)均值高于常规剂量组[(67.07 ±19.94) mmHg、(62.93±21.71) mmHg、(67.95±23.79)mmHg],但差异无统计学意义(P＞0.05).2组患儿用药后吸入氧体积分数(FiO2)和动脉血二氧化碳分压[pa(CO2)]下降,持续至48 h(P均＜0.05).珂立苏用药后2组患儿的氧合指数(OI)和动脉/肺泡氧分压(a/APO2)改善,且高剂量组OI用药后1h、12h、24 h、36 h、48 h分别为6.1±2.8、5.6±3.3、5.5±3.5、5.8±4.5、5.3±3.1,较用药前(8.9±4.0)下降显著(P＜0.01).高剂量组a/APO2用药后1h、12h、24 h、36 h、48 h为0.39 ±0.22、0.42±0.20、0.45±0.22、0.44±0.22、0.46 ±0.21,较用药前(0.27±0.18)显著改善(P＜0.01).高剂量组较常规剂量组机械通气及氧疗时间缩短[(94.54±113.44)h比(109.27±124.87)h,(259.10 ±280.45)h比(372.31 ±398.08)h],但差异无统计学意义(P均＞0.05).2组并发症发生率(肺炎、气胸、颅内出血、动脉导管未闭、肺出血、坏死性小肠结肠炎、脓毒症等)比较差异无统计学意义(P＞0.05).结论 珂立苏用药可有效改善NRDS患儿pa(O2)、OI、a/APO2,降低FiO2,珂立苏100 mg/kg比70 mg/kg能更有效改善上述参数,且缩短NRDS患儿机械通气及氧疗时间,高剂量珂立苏给药不增加并发症风险.
目的 觀察不同劑量肺錶麵活性劑(珂立囌)治療新生兒呼吸窘迫綜閤徵(NRDS)的臨床療效.方法 研究對象為江囌省4傢新生兒重癥鑑護病房內診斷為NRDS、＜2 500 g的早產兒,根據珂立囌首劑量分為高劑量治療組(69例)和常規劑量治療組(61例).高劑量組患兒予珂立囌100 mg/kg,常規劑量組予珂立囌70 mg/kg.比較2組患兒氧閤指數、機械通氣、氧療時間及相關併髮癥等情況.結果 2組患兒用藥後動脈血氧分壓[pa(O2)]迅速改善,高劑量組用藥1h、12 h、24 hpa(O2)升至(80.27±36.81) mmHg(1 mmHg=0.133kPa)、(73.03 ±24.94) mmHg、(72.35 ±24.72) mmHg,改善尤為顯著,差異均有統計學意義(P均＜0.05).同時點高劑量組pa(O2)均值高于常規劑量組[(67.07 ±19.94) mmHg、(62.93±21.71) mmHg、(67.95±23.79)mmHg],但差異無統計學意義(P＞0.05).2組患兒用藥後吸入氧體積分數(FiO2)和動脈血二氧化碳分壓[pa(CO2)]下降,持續至48 h(P均＜0.05).珂立囌用藥後2組患兒的氧閤指數(OI)和動脈/肺泡氧分壓(a/APO2)改善,且高劑量組OI用藥後1h、12h、24 h、36 h、48 h分彆為6.1±2.8、5.6±3.3、5.5±3.5、5.8±4.5、5.3±3.1,較用藥前(8.9±4.0)下降顯著(P＜0.01).高劑量組a/APO2用藥後1h、12h、24 h、36 h、48 h為0.39 ±0.22、0.42±0.20、0.45±0.22、0.44±0.22、0.46 ±0.21,較用藥前(0.27±0.18)顯著改善(P＜0.01).高劑量組較常規劑量組機械通氣及氧療時間縮短[(94.54±113.44)h比(109.27±124.87)h,(259.10 ±280.45)h比(372.31 ±398.08)h],但差異無統計學意義(P均＞0.05).2組併髮癥髮生率(肺炎、氣胸、顱內齣血、動脈導管未閉、肺齣血、壞死性小腸結腸炎、膿毒癥等)比較差異無統計學意義(P＞0.05).結論 珂立囌用藥可有效改善NRDS患兒pa(O2)、OI、a/APO2,降低FiO2,珂立囌100 mg/kg比70 mg/kg能更有效改善上述參數,且縮短NRDS患兒機械通氣及氧療時間,高劑量珂立囌給藥不增加併髮癥風險.
목적 관찰불동제량폐표면활성제(가립소)치료신생인호흡군박종합정(NRDS)적림상료효.방법 연구대상위강소성4가신생인중증감호병방내진단위NRDS、＜2 500 g적조산인,근거가립소수제량분위고제량치료조(69례)화상규제량치료조(61례).고제량조환인여가립소100 mg/kg,상규제량조여가립소70 mg/kg.비교2조환인양합지수、궤계통기、양료시간급상관병발증등정황.결과 2조환인용약후동맥혈양분압[pa(O2)]신속개선,고제량조용약1h、12 h、24 hpa(O2)승지(80.27±36.81) mmHg(1 mmHg=0.133kPa)、(73.03 ±24.94) mmHg、(72.35 ±24.72) mmHg,개선우위현저,차이균유통계학의의(P균＜0.05).동시점고제량조pa(O2)균치고우상규제량조[(67.07 ±19.94) mmHg、(62.93±21.71) mmHg、(67.95±23.79)mmHg],단차이무통계학의의(P＞0.05).2조환인용약후흡입양체적분수(FiO2)화동맥혈이양화탄분압[pa(CO2)]하강,지속지48 h(P균＜0.05).가립소용약후2조환인적양합지수(OI)화동맥/폐포양분압(a/APO2)개선,차고제량조OI용약후1h、12h、24 h、36 h、48 h분별위6.1±2.8、5.6±3.3、5.5±3.5、5.8±4.5、5.3±3.1,교용약전(8.9±4.0)하강현저(P＜0.01).고제량조a/APO2용약후1h、12h、24 h、36 h、48 h위0.39 ±0.22、0.42±0.20、0.45±0.22、0.44±0.22、0.46 ±0.21,교용약전(0.27±0.18)현저개선(P＜0.01).고제량조교상규제량조궤계통기급양료시간축단[(94.54±113.44)h비(109.27±124.87)h,(259.10 ±280.45)h비(372.31 ±398.08)h],단차이무통계학의의(P균＞0.05).2조병발증발생솔(폐염、기흉、로내출혈、동맥도관미폐、폐출혈、배사성소장결장염、농독증등)비교차이무통계학의의(P＞0.05).결론 가립소용약가유효개선NRDS환인pa(O2)、OI、a/APO2,강저FiO2,가립소100 mg/kg비70 mg/kg능경유효개선상술삼수,차축단NRDS환인궤계통기급양료시간,고제량가립소급약불증가병발증풍험.
Objective To evaluate the relative efficacy of different dosages of Calf Pulmonary Surfactant (Calsurf) administration in premature infants with established respiratory distress syndrome (NRDS).Methods Four neonatal intensive care units in Jiangsu province were enrolled.Premature infants,birth weight ＜ 2 500 g,with NRDS,received 70 mg/kg (61 cases)or 100 mg/kg (69 cases)Calsurf.Clinical and respiratory parameters were recorded.The primary outcome measures were blood gas analysis of 1 h,12 h and 36 h after administration,the need for oxygenation and ventilatory requirements and the adverse events of NRDS.Results Arterial oxygen tension[pa (O2)] results in a significant improvement(80.27-±36.81) mmHg,(73.03 ±24.94) mmHg and (72.35 ± 24.72) mmHg at 1 h,12 h and 24 h in higher dose group(P ＜ 0.05),(67.95 ± 23.79) mmHg,(72.35 ± 24.72) mmHg in 24 h,as compared with the lower dose group at the same time [(67.07 ± 19.94) mmHg,(62.93 ± 21.71) mmHg,(67.95 ±-23.79) mmHg] (P ＞ 0.05).Inspired oxygen (FiO2) and pa (O2) decreased after administration in two groups and the duration of FiO2 decline lasted to 48 h (all P ＜ 0.05).The oxygen index (OI) was improved after Calsurf administration,especially in the infants who received 100 mg/kg of Calsurf with 6.1 ± 2.8,5.6 ± 3.3,5.5 ± 3.5,5.8 ± 4.5,5.3 ± 3.1 in 1 h,12 h,24 h,36 h,48 h,respectively(P ＜ 0.01).The arterial-to-alveolar oxygen tension ratio (a/APO2) of 100 mg/kg group was reduced significantly in 1 h,12 h,24 h,36 h,48 h with 0.39 ±0.22,0.42 ±0.20,0.45 ± 0.22,0.44 ± 0.22,0.46 ± 0.21 as compared with 0.27 ± 0.18 which was at the time point before administration (P ＜ 0.01).Although not statistically significant,the mean time of duration of mechanical ventilation and oxygen inhalation of higher dose group were decreased as compared to the lower dose group [(94.54 ± 113.44) h vs (109.27 ± 124.87) h (P＞0.05) and (259.10 ±280.45) vs (372.31 ±398.08) h(P ＞0.05)].There were no significant differences in the rates of other adverse events such as pneumonia,pneumothorax,intracranial hemorrhage,patent ductus arteriosus (PDA),pneumorrhagia,necrotizing enterocolitis,septicemia between two groups (P ＞ 0.05).Conclusions Calsurf given to preterm infants with NRDS at a dose of 100 mg/kg resulted in a higher Pa (O2),a/APO2,better OI and lower FiO2 as compared with those receiving 70 mg/kg.The need for mechanical ventilation and oxygen supplement were reduced with higher-dose administration.Large dose of Calsurf did not increase the risk of complications as mentioned above.
