肺表面活性物质联合布地奈德预防极低出生体重儿支气管肺发育不良的疗效观察

潘静; 陈名武; 倪文泉; 方涛; 张慧; 陈冶; 潘家华

doi:10.7499/j.issn.1008-8830.2017.02.002

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中国当代儿科杂志 ›› 2017, Vol. 19 ›› Issue (2) : 137-141. DOI: 10.7499/j.issn.1008-8830.2017.02.002

论著·临床研究

肺表面活性物质联合布地奈德预防极低出生体重儿支气管肺发育不良的疗效观察

潘静, 陈名武, 倪文泉, 方涛, 张慧, 陈冶, 潘家华

作者信息 +

Clinical efficacy of pulmonary surfactant combined with budesonide for preventing bronchopulmonary dysplasia in very low birth weight infants

PAN Jing, CHEN Ming-Wu, NI Wen-Quan, FANG Tao, ZHANG Hui, CHEN Ye, PAN Jia-Hua

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摘要

目的探讨肺表面活性物质（PS）联合布地奈德气管内滴入预防极低出生体重早产儿支气管肺发育不良（BPD）的临床疗效。方法选取胎龄 < 32周的患有宫内感染的呼吸窘迫综合征（NRDS）（Ⅲ或Ⅳ级）的极低出生体重儿30例，随机分成PS+布地奈德组（15例）和PS组（15例）。比较两组血气分析、氧合指数（OI）、呼吸机使用时间、吸氧时间、BPD发生率、纠正胎龄36周时病死率以及其他并发症的发生率。结果 PS+布地奈德组患儿BPD发生率低于PS组，呼吸机使用时间和吸氧时间明显短于PS组（P < 0.05）；给药后第2~6天，PS+布地奈德组pH、OI均高于PS组，PaCO₂ 均低于PS组，且差异均有统计学意义（P < 0.05）；两组间纠正胎龄36周时病死率以及其他并发症差异无统计学意义。结论 PS联合布地奈德气管内滴入能有效降低重度NRDS极低出生体重早产儿BPD的发生率。

Abstract

Objective To explore the clinical efficacy of intratracheal instillation of pulmonary surfactant (PS) combined with budesonide for preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. Methods Thirty VLBW infants with gestational age < 32 weeks who developed neonatal respiratory distress syndrome (NRDS) (grade Ⅲ-IV) suffering from intrauterine infection were randomly assigned into a PS+budesonide group and a PS alone group. The changes were compared between the two groups in arterial blood gas indexes, oxygenation index (OI), duration of mechanical ventilation, duration of oxygen supplementation, incidence of BPD, mortality rate at 36 weeks corrected gestational age and incidences of other complications except BPD. Results Compared with the PS alone group, the PS+budesonide group had a lower incidence of BPD, shorter duration of mechanical ventilation and oxygen supplementation (P < 0.05). On the 2nd to 6th day after treatment, the PS+budesonide group had higher pH value of arterial blood gas and OI and lower carbon dioxide partial pressure compared with the PS alone group (P < 0.05). There were no significant differences in the mortality rate at 36 weeks corrected gestational age and the incidences of other complications except BPD between the two groups (P > 0.05). Conclusions Intratracheal instillation of PS combined with budesonide can effectively reduce the incidence of BPD in VLBW premature infants with severe NRDS.

导出引用

潘静, 陈名武, 倪文泉, 方涛, 张慧, 陈冶, 潘家华. 肺表面活性物质联合布地奈德预防极低出生体重儿支气管肺发育不良的疗效观察[J]. 中国当代儿科杂志. 2017, 19(2): 137-141 https://doi.org/10.7499/j.issn.1008-8830.2017.02.002

PAN Jing, CHEN Ming-Wu, NI Wen-Quan, FANG Tao, ZHANG Hui, CHEN Ye, PAN Jia-Hua. Clinical efficacy of pulmonary surfactant combined with budesonide for preventing bronchopulmonary dysplasia in very low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics. 2017, 19(2): 137-141 https://doi.org/10.7499/j.issn.1008-8830.2017.02.002

参考文献

[1] Wang J,Liu X,Zhu T,et al.Analysis of neonatal respiratory distress syndrome among different gestational segments[J].Int J Clin Exp Med,2015,8(9):16273-16279.
[2] Herting E.Bronchopulmonary dysplasia:pathogenesis,risk factors and early prevention strategies[J].Chin Med J (Engl),2010,123(20):2955-2957.
[3] Westover AJ,Moss TJ.Effects of intrauterine infection or inflammation on fetal lung development[J].Clin Exp Pharmacol Physiol,2012,39(9):824-830.
[4] Speer C P.Chorioamnionitis,postnatal factors and proinflammatory response in the pathogenetic sequence of bronchopulmonary dysplasia[J].Neonatology,2009,95(4):353-361.
[5] Tropea K,Christou H.Current pharmacologic approaches for prevention and treatment of bronchopulmonary dysplasia[J].Int J Pediatr,2012,2012:598606.
[6] Cole CH,Colton T,Shah BL,et al.Early inhaled glucocorticoid therapy to prevent bronchopulmonary dysplasia[J].N Engl J Med,1999,340(13):1005-1010.
[7] Yang CF,Jeng MJ,Soong WJ,et al.Acute pathophysiological effects of intratracheal instillation of budesonide and exogenous surfactant in a neonatal surfactant-depleted piglet model[J].Pediatr Neonatal,2010,51(4):219-226.
[8] Yeh TF,Lin HC,Chang CH,et al.Early intratracheal instillation of budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants:a pilot study[J].Pediatrics,2008,121(5):e1310-e1318.
[9] Hartling L,Liang Y,Lacaze-Masmonteil T.Chorioamnionitis as a risk factor for bronchopulmonary dysplasia:a systematic review and meta-analysis[J].Arch Dis Child Fetal Neonatal Ed,2012,97(1):F8-F17.
[10] Aksakal SE,Kandemir O,Alt?nbas S,et al.Fetal tyhmus size as a predictor of histological chorioamnionitis in preterm premature rupture of membranes[J].J Matern Fetal Neonatal Med,2014,27(11):1118-1122.
[11] 李文斌,常立文.胎儿炎症反应综合征与新生儿疾病[J].临床儿科杂志,2013,13(9):801-804.
[12] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011:395-398.
[13] Jobe AH,Bancalari E.Bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2001,163(7):1723-1729.
[14] Sinclair JC,Bottino M,Cowett RM.Interventions for prevention of neonatal hyperglycemia in very low birth weight infants[J].Cochrane Database Syst Rev,2011,5(10):7615-7617.
[15] Dionne JM,Abitbol CL,Flynn JT.Hypertension in infancy:diagnosis,management and outcome[J].Pediatr Nephrol,2012,27(1):17-32.
[16] Trevisanuto D,Doglioni N,Ferrarese P,et al.Neonatal pneumothorax:comparison between neonatal transfers and inborn infants[J].J Perinat Med,2005,33(5):449-454.
[17] Skinner J.Diagnosis of patent ductus arteriosus[J].Semin Neonatol,2001,6(1):49-61.
[18] Jodeiry B,Heidarzadeh M,Sahmani-Asl S,et al.Study of intraventricular hemorrhage in VLBW neonates admitted in Al-Zahra Hospital,Tabriz,Iran[J].Niger J Med,2012,21(1):92-97.
[19] Müller MJ,Paul T,Seeliger S.Necrotizing enterocolitis in premature infants and newborns[J].J Neonatal Perinatal Med,2016,9(3):233-242.
[20] 李燕,韦秋芬,潘新年,等.早产儿支气管肺发育不良严重程度的影响因素[J].中国新生儿科杂志,2014,16(10):1014-1018.
[21] Yang CF,Lin CH,Chiou SY,et al.Intratracheal budesonide supplementation in addition to surfactant improves pulmonary outcome in surfactant-depleted newborn piglets[J].Pediatr Pulmonol,2013,48(2):151-159.
[22] Rhen T,Cidlowski JA.Antiinflammatory action of glucocorticoids-new mechanisms for old drugs[J].N Engl J Med,2005,353(16):1711-1723.
[23] Gupta S,Prasanth K,Chen CM,et al.Postnatal corticosteroids for prevention and treatment of chronic lung disease in the preterm newborn[J].Int J Pediatr,2012,2012:315642.
[24] Barrette AM,Roberts JK,Chapin C,et al.Antiinflammatory effects of budesonide in human fetal lung[J].Am J Respir Cell Mol Biol,2016,55(5):623-632.
[25] Yeh TF,Chen CM,Wu SY,et al.Intratracheal administration of budesonide/surfactant to prevent bronchopulmonary dysplasia[J].Am J Respir Crit Care Med,2016,193(1):86-95.
[26] Kuo HT,Lin HC,Tsai CH,et al.A follow-up study of preterm infants given budesonide using surfactant as a vehicle to prevent chronic lung disease in preterm infants[J].J Pediatr,2010,156(4):537-541.