不同角度注入肺表面活性物质对早产儿支气管肺发育不良和颅内出血的影响：一项前瞻性随机对照研究

戴雪凤; 朱昂昂; 谢婷婷; 熊玉红; 孟伦; 陈名武

doi:10.7499/j.issn.1008-8830.2311066

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中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (4) : 337-342. DOI: 10.7499/j.issn.1008-8830.2311066

论著·临床研究

不同角度注入肺表面活性物质对早产儿支气管肺发育不良和颅内出血的影响：一项前瞻性随机对照研究

戴雪凤¹, 朱昂昂², 谢婷婷³, 熊玉红³, 孟伦³, 陈名武^1,3

作者信息 +

Impact of different angles of pulmonary surfactant administration on bronchopulmonaryplasia and intracranial hemorrhage in preterm infants: a prospective randomized controlled study

DAI Xue-Feng, ZHU Ang-Ang, XIE Ting-Ting, XIONG Yu-Hong, MENG Lun, CHEN Ming-Wu

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摘要

目的不同角度注入肺表面活性物质对早产儿支气管肺发育不良和颅内出血发生的影响。方法前瞻性纳入2019年1月—2023年5月就诊于安徽医科大学附属省立医院新生儿科的146例早产儿（胎龄<32周）为研究对象。随机分为不同角度注入肺表面活性物质组，即0°组（34例）、30°组（36例）、45°组（38例）、60°组（38例），分析比较各组临床指标和结局的差异。结果 60°组给药后的氧合指数低于其他3组，使用有创呼吸机时间、用氧时间短于其他3组，支气管肺发育不良发生率低于其他3组（P<0.05）。60°组颅内出血发生率低于0°组（P<0.05）。60°组治愈率高于0°组和30°组（P<0.05）。结论 60°角注入肺表面活性物质的临床疗效高于其他角度，且能降低早产儿颅内出血和支气管肺发育不良的发生率。

Abstract

Objective To investigate the effects of different angles of pulmonary surfactant (PS) administration on the incidence of bronchopulmonary dysplasia and intracranial hemorrhage in preterm infants. Methods A prospective study was conducted on 146 preterm infants (gestational age <32 weeks) admitted to the Department of Neonatology, Provincial Hospital Affiliated to Anhui Medical University from January 2019 to May 2023. The infants were randomly assigned to different angles for injection of pulmonary surfactant groups: 0° group (34 cases), 30° group (36 cases), 45° group (38 cases), and 60° group (38 cases). Clinical indicators and outcomes were compared among the groups. Results The oxygenation index was lower in the 60° group compared with the other three groups, with shorter invasive ventilation time and oxygen use time, and a lower incidence of bronchopulmonary dysplasia than the other three groups (P<0.05). The incidence of intracranial hemorrhage was lower in the 60° group compared to the 0° group (P<0.05). The cure rate in the 60° group was higher than that in the 0° group and the 30° group (P<0.05). Conclusions The clinical efficacy of injection of pulmonary surfactant at a 60° angle is higher than other angles, reducing the incidence of intracranial hemorrhage and bronchopulmonary dysplasia in preterm infants.

导出引用

戴雪凤, 朱昂昂, 谢婷婷, 熊玉红, 孟伦, 陈名武. 不同角度注入肺表面活性物质对早产儿支气管肺发育不良和颅内出血的影响：一项前瞻性随机对照研究[J]. 中国当代儿科杂志. 2024, 26(4): 337-342 https://doi.org/10.7499/j.issn.1008-8830.2311066

DAI Xue-Feng, ZHU Ang-Ang, XIE Ting-Ting, XIONG Yu-Hong, MENG Lun, CHEN Ming-Wu. Impact of different angles of pulmonary surfactant administration on bronchopulmonaryplasia and intracranial hemorrhage in preterm infants: a prospective randomized controlled study[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(4): 337-342 https://doi.org/10.7499/j.issn.1008-8830.2311066

参考文献

1 Htun ZT, Schulz EV, Desai RK, et al. Postnatal steroid management in preterm infants with evolving bronchopulmonary dysplasia[J]. J Perinatol, 2021, 41(8): 1783-1796. PMID: 34012057. PMCID: PMC8133053. DOI: 10.1038/s41372-021-01083-w.
2 Jensen EA, Edwards EM, Greenberg LT, et al. Severity of bronchopulmonary dysplasia among very preterm infants in the United States[J]. Pediatrics, 2021, 148(1): e2020030007. PMID: 34078747. PMCID: PMC8290972. DOI: 10.1542/peds.2020-030007.
3 Jensen EA, Dysart K, Gantz MG, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. An evidence-based approach[J]. Am J Respir Crit Care Med, 2019, 200(6): 751-759. PMID: 30995069. PMCID: PMC6775872. DOI: 10.1164/rccm.201812-2348OC.
4 Lui K, Lee SK, Kusuda S, et al. Trends in outcomes for neonates born very preterm and very low birth weight in 11 high-income countries[J]. J Pediatr, 2019, 215: 32-40.e14. PMID: 31587861. DOI: 10.1016/j.jpeds.2019.08.020.
5 张蓉, 林新祝, 常艳美, 等. 早产儿支气管肺发育不良营养管理专家共识[J]. 中国当代儿科杂志, 2020, 22(8): 805-814. PMID: 32800025. PMCID: PMC7441505. DOI: 10.7499/j.issn.1008-8830.2005080.
6 Gilfillan M, Bhandari A, Bhandari V. Diagnosis and management of bronchopulmonary dysplasia[J]. BMJ, 2021, 375: n1974. PMID: 34670756. DOI: 10.1136/bmj.n1974.
7 Thébaud B, Goss KN, Laughon M, et al. Bronchopulmonary dysplasia[J]. Nat Rev Dis Primers, 2019, 5(1): 78. PMID: 31727986. PMCID: PMC6986462. DOI: 10.1038/s41572-019-0127-7.
8 朱佳骏. LISA/MIST技术与早产儿呼吸系统疾病的预后[J]. 中国实用儿科杂志, 2018, 33(5): 338-341. DOI: 10.19538/j.ek2018050605.
9 李晓东, 田青, 包忠宪, 等. 不同体位气管内注入固尔苏疗效分析[J]. 实用医学杂志, 2007, 23(11): 1728-1730. DOI: 10.3969/j.issn.1006-5725.2007.11.065.
10 胡岩, 徐晓燕, 周凤玲, 等. 不同体位气管内注入固尔苏治疗新生儿呼吸窘迫综合征疗效观察[J]. 中国误诊学杂志, 2009, 9(1): 39-40.
11 林楚兰, 熊丽, 范星. 不同体位气管内注入固尔苏治疗新生儿呼吸窘迫综合征疗效观察[J]. 中国医药导报, 2011, 8(22): 167-168. DOI: 10.3969/j.issn.1673-7210.2011.22.078.
12 Jobe AH, Bancalari E. Bronchopulmonary dysplasia[J]. Am J Respir Crit Care Med, 2001, 163(7): 1723-1729. PMID: 11401896. DOI: 10.1164/ajrccm.163.7.2011060.
13 王淳, 吕鑫, 史歆然. 颅脑超声在新生儿颅内出血诊断中的应用价值[J]. 影像科学与光化学, 2022, 40(3): 570-573. DOI:10.7517/issn.1674-0475.211113.
14 Repka MX. A revision of the international classification of retinopathy of prematurity[J]. Ophthalmology, 2021, 128(10): 1381-1383. PMID: 34332760. DOI: 10.1016/j.ophtha.2021.07.014.
15 Trembath A, Hornik CP, Clark R, et al. Comparative effectiveness of surfactant preparations in premature infants[J]. J Pediatr, 2013, 163(4): 955-960.e1. PMID: 23769501. PMCID: PMC3779477. DOI: 10.1016/j.jpeds.2013.04.053.
16 Kalikkot Thekkeveedu R, Guaman MC, Shivanna B. Bronchopulmonary dysplasia: a review of pathogenesis and pathophysiology[J]. Respir Med, 2017, 132: 170-177. PMID: 29229093. PMCID: PMC5729938. DOI: 10.1016/j.rmed.2017.10.014.
17 Kalikkot Thekkeveedu R, El-Saie A, Prakash V, et al. Ventilation-induced lung injury (VILI) in neonates: evidence-based concepts and lung-protective strategies[J]. J Clin Med, 2022, 11(3): 557. PMID: 35160009. PMCID: PMC8836835. DOI: 10.3390/jcm11030557.
18 Capasso L, Vento G, Loddo C, et al. Oxidative stress and bronchopulmonary dysplasia: evidences from microbiomics, metabolomics, and proteomics[J]. Front Pediatr, 2019, 7: 30. PMID: 30815432. PMCID: PMC6381008. DOI: 10.3389/fped.2019.00030.
19 Cannavò L, Perrone S, Viola V, et al. Oxidative stress and respiratory diseases in preterm newborns[J]. Int J Mol Sci, 2021, 22(22): 12504. PMID: 34830385. PMCID: PMC8625766. DOI: 10.3390/ijms222212504.
20 Salimi U, Dummula K, Tucker MH, et al. Postnatal sepsis and bronchopulmonary dysplasia in premature infants: mechanistic insights into "new BPD"[J]. Am J Respir Cell Mol Biol, 2022, 66(2): 137-145. PMID: 34644520. PMCID: PMC8845139. DOI: 10.1165/rcmb.2021-0353PS.
21 Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018, 197: 300-308. PMID: 29551318. PMCID: PMC5970962. DOI: 10.1016/j.jpeds.2018.01.043.
22 Zheng Y, Wu Q, Han S. Inhaled nitric oxide in premature infants for preventing bronchopulmonary dysplasia: a meta-analysis[J]. BMC Pediatr, 2023, 23(1): 139. PMID: 36991371. PMCID: PMC10053486. DOI: 10.1186/s12887-023-03923-4.
23 Kamath BD, Macguire ER, McClure EM, et al. Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries[J]. Pediatrics, 2011, 127(6): 1139-1146. PMID: 21536613. PMCID: PMC9923778. DOI: 10.1542/peds.2010-3212.
24 Yang L, Bao Z, Zhang L, et al. Position management on pulmonary function and bronchopulmonary dysplasia in premature infants: study protocol for a randomised controlled trial[J]. BMJ Open, 2022, 12(12): e062291. PMID: 36521889. PMCID: PMC9756205. DOI: 10.1136/bmjopen-2022-062291.
25 Dumpa V, Bhandari V. Surfactant, steroids and non-invasive ventilation in the prevention of BPD[J]. Semin Perinatol, 2018, 42(7): 444-452. PMID: 30343941. DOI: 10.1053/j.semperi.2018.09.006.
26 Sharma A, Xin Y, Chen X, et al. Early prediction of moderate to severe bronchopulmonary dysplasia in extremely premature infants[J]. Pediatr Neonatol, 2020, 61(3): 290-299. PMID: 32217025. DOI: 10.1016/j.pedneo.2019.12.001.