肺表面活性物质对不同胎龄早产儿肺透明膜病的预防作用

目的 分析不同胎龄早产儿应用肺表面活性物质(PS)预防新生儿肺透明膜病(HMD)的临床疗效及安全性,探讨应用PS预防HMD的最佳时机.方法 2000年9月至2006年9月3所医院NICU收治胎龄＜35周的早产儿911例,其中预防性应用PS 146例(预防组),未预防性应用PS 765例(非预防组).比较两组间不同胎龄早产儿的HMD患病率、7d内病死率、机械通气时间、总吸氧时间、住院时间及主要并发症的发生情况.结果 预防组HMD患病率较非预防组降低了28.1%(P＜0.05).预防组中胎龄＜30周、30周和31周早产儿HMD患病率较非预防组分别降低了43.2%、58.4%、50.9%(P＜0.05).预防组7d内病死率(6.2%)较非预防组(18.2%)明显降低(P＜0.05);其胎龄＜30周、30周和31周早产儿7d内病死率分别减低了23.0%、26.0%、17.6%(P＜0.05).预防组机械通气时间、总吸氧时间均较非预防组明显降低(P＜0.05);但住院时间差异无显著性(P＞0.05).预防组肺出血、呼吸机相关性肺炎、气漏的发生率均低于非预防组(P＜0.05).结论 预防性应用PS可减少HMD患病率,降低早产儿的病死率,缩短机械通气和总吸氧时间,减少肺出血、呼吸机相关性肺炎、气漏的发生率.胎龄≤31周的早产儿预防性应用PS效果更为显著. 18.2%)明显降低(P＜0.05);其胎龄＜30周、30周和31周早产儿7d内病死率分别减低了23.0%、26.O%、17.6%(P＜0.05).预防组机械通气时间、总吸氧时间均较非预防组明显降低(P＜0.05);但住院时间差异无显著性(P＞0.05).预防组肺出血、呼吸机相关性肺炎、气漏的发生率均低于非预防组(P＜0.05).结论 预防性应用PS可减少HMD患病率,降低 产儿的病死率,缩短机械通气和总吸氧时间,减少肺出血、呼吸机相关性肺炎、气漏的发生率.胎龄≤31周的早产儿预防性应用PS效果更为显著. 18.2%)明显降低(P＜0.05);其胎龄＜30周、30周和31周早产儿7d内病死率分别减低了23.0%、26.O%、17.6%(P＜0.05).预防组机械通气时间、总吸氧时间均较非预防组明显降低(P＜0.05);但住院时间差异无显

The prophylaxis of pulmonary surfactant on hyaline membrane disease in preterm infants with different gestatiooal ages

Objective To evaluate the clinical effects and safety of pulmonary surfactant (PS) on-hya line membrane disease (HMD) in preterm infants of different gestational ages, and to discuss the best opportu-nity for prophylaxis on HMD with PS. Methods Nine hundred and eleven preterm infants with gestational a-ges (GA) ＜35 weeks were analyzed retrospectively,among which 146 babies given PS prophylactically were classified as Group A,and the other 765 babies without PS as Group B. HMD morbidity and mortality within 7 days,as well as the period of mechanical ventilation,oxygen therapy and hospitalization and major complica-tions were analyzed statistically in both groups. Results Compared to Group B,HMD morbidity within 7 days was significantly lower by 28. 1% (P＜ 0.05) in Group A. HMD morbidities within 7 days in babies with GA ＜ 30 weeks,GA =30 weeks and 31 weeks of Group A were reduced by 43.2% ,58.4% and 50.9% respectively. A significant difference in the 7-days mortality was observed between Group A (6.2%) and Group B (18.2% ). The mortality of babies with GA <30 weeks,GA =30 weeks,GA =31 weeks in Group A reduced by 23.0% ,26.0% and 17.6% respectively with prophylactic administration of PS. There were significant differ-ences in the time of ventilation and oxygen therapy (P ＜ 0.05), but no difference was showed in the time of hospitalization between two groups( P ＞0.05). Compared to Group B,Group A had a lower incidence of lung hemorrhage, ventilator-associated pneumonia and air leak (P＜0.05). Conclusion Prophylactic administration of PS results in lower HMD morbidity and mortality,shortening the time of ventilation and oxygen therapy, as well as reducing complication incidence such as lung hemorrhage,ventilator-associated pneumonia,air leak,par-ticularly in the preterm infants with GA≤31 weeks.