| 赵明明,刘玉娟,李忠良,等.LISA技术治疗超低出生体质量儿呼吸窘迫综合征 28例[J].安徽医药,2024,28(1):143-147. |
| LISA技术治疗超低出生体质量儿呼吸窘迫综合征 28例 |
| LISA technique in the treatment of respiratory distress syndrome in 28 cases of infants with ultralow birth mass |
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| DOI：10.3969/j.issn.1009-6469.2024.01.030 |
| 中文关键词: 呼吸窘迫综合征，新生儿 肺表面活性物质相关蛋白质类 连续气道正压通气 经微管气管内注入肺表面活性物质(LISA) 婴儿，超低出生体质量 |
| 英文关键词: Respiratory distress syndrome, newborn Pulmonary surfactant-associated proteins Continuous positive airway pres- sure Less invasive surfactant administration (LISA) Infant, ultralow birth weight |
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| 中文摘要: |
| 目的探讨经鼻持续气道正压通气( nasal continuous positive airway pressure，nCPAP)下经微管气管内注入肺表面活性物质( less invasive surfactant administration，LISA)技术在超低出生体质量儿呼吸窘迫综合征( respiratory distress syndrome，RDS)治疗中的应用与疗效。方法采取前瞻性研究方法，选取潍坊市妇幼保健院新生儿科重症监护病房( neonatalintensive ca- reunit，NICU)2019年 7月至 2021年 4月收治的超低出生体质量儿( 58例)为研究对象。应用随机数字表法分为 LISA组( 28例)和气管插管 -注入 PS-拔管给予经鼻持续气道正压通气( intubation-surfactant-extubation，INSURE)组( 30例)。 LISA组采用 LISA技术，在 nCPAP下，气管内置入微管并注入肺表面活性物质( pulmonarysurfactant，PS)； INSURE组采用 INSURE技术，拔管后给予 nCPAP辅助通气。观察并比较两组病儿给药过程、给药前后呼吸机参数、动脉血气、用氧时间及并发症的发生率。结果 LISA组病儿 72 h内机械通气率低于 INSURE组，差异有统计学意义(21.4%比 46.7%，P=0.043)； LISA组病儿住院期间无创正压通气时间( 404.50 h比 483.50 h，P=0.033)及总用氧时间( 520.00 h比 612.50 h，P=0.040)低于 INSURE组； LISA组给药 1h后动脉血氧分压( arterial partialpressureof O2，PaO2)变化高于 INSURE组［(54.29±5.69)mmHg比( 52.87±3.27)mmHg，P＝0.038］，差异有统计学意义； LISA组支气管肺发育不良( 25.0%比 53.3%，P=0.028)及有血流动力学意义的动脉导管未闭发生率( 28.6%比56.7%，P=0.031)低于 INSURE组，均差异有统计学意义。结论在超低出生体质量儿 RDS治疗中， LISA技术在减少 72 h内机械通气率、住院期间用氧时间、近期并发症等方面具有优势，是一种安全有效的治疗超低出生体质量儿 RDS的方法。 |
| 英文摘要: |
| Objective To investigate the application and treatment efficacy of the less invasive surfactant administration (LISA) tech-nique under nasal continuous positive airway pressure (nCPAP) in the treatment of respiratory distress syndrome (RDS) in infants withultralow birth mass.Methods A prospective study was conducted. Ultralow birth mass children (58 cases) admitted to the neonatal in-tensive care unit (NICU) of W.F.Maternal and Child Health Hospital from July 2019 to April 2021 were selected as the study subjects.The study subjects were divided into the LISA group (28 cases) and the intubation-surfactant-extubation (INSURE) group (30 cases) ac-cording to the random number table method. The LISA group used the LISA technique, in which a microtube was placed into the tra-chea and injected with pulmonary surfactant (PS) under nCPAP. The INSURE group used the INSURE technique, in which tracheal in-tubation-PS. The INSURE group used the INSURE technique, i.e., tracheal intubation-PS, INSURE, and nCPAP was given to assistventilation after extubation. The process of drug administration, respiratory parameters, arterial blood gases, oxygen duration and inci-dence of complications before and after drug administration were observed and compared between the two groups.Results The rate of mechanical ventilation in the LISA group was lower than that in the INSURE group within 72 h, and the difference was statistically sig-nificant (21.4% vs. 46.7%, P = 0.043). The duration of noninvasive positive pressure ventilation (404.50 h vs. 483.50 h, P = 0.033) and the total duration of oxygen use (520.00 h vs. 612.50 h, P = 0.040) were lower than those of the INSURE group. The change in arterial partial pressure of O2 (PaO2) in the LISA group was higher than that in the INSURE group [(54.29±5.69) mmHg vs. (52.87±3.27) mmHg, P = 0.038] after the administration of drugs for 1 h, and the difference was statistically significant. The incidence of dysplasia (25.0% vs. 53.3%, P = 0.028) and hemodynamically significant arterial duct failure (28.6% vs. 56.7%, P = 0.031) was lower in the LISA group than in the INSURE group, and the difference was statistically significant in both cases.Conclusion In the treatment of RDS in in- fants with ultralow birth mass, the LISA technique has advantages in reducing the rate of mechanical ventilation within 72 h, the dura-tion of oxygen use during hospitalization, and recent complications, making it a safe and effective treatment for RDS in infants with ul-tralow birth mass. |
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