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肺超声评分指导早产儿表面活性剂治疗的价值分析
作者:温宇楠 刘艳凤 白文婷 
单位:大连市妇女儿童医疗中心(集团) 辽宁 大连 116000 
关键词:肺超声评分 呼吸窘迫综合征 早产儿 肺表面活性物质 支气管肺发育不良 
分类号:R 445
出版年,卷(期):页码:2023,40(1):9-12
摘要:

 摘要:目的 探讨肺部超声评分(LUS)早期指导呼吸窘迫综合征(RDS)早产儿应用肺表面活性物质(PS)治疗的价值。方法 选取2017年3月—2019年4月本院新生儿重症监护室(NICU)收治的184例RDS早产儿,按照随机数字表法将其分为超声指导组和对照组,每组各92例。两组早产儿出生后即转入NICU进行持续气道正压通气(CPAP)治疗,超声指导组在出生后3 h内进行肺部超声检查,当LUS评分>4分或吸入氧浓度(FiO2)>0.4时给予PS治疗,对照组仅当FiO2>0.4时给予PS治疗;首剂200 mg/kg,若12 h后FiO2>0.4则给予第2剂100 mg/kg。观察两组早产儿早期PS使用率、使用PS前最大FiO2值;比较两组早产儿CPAP时间、有创通气时间、氧疗时间、28 d内未使用呼吸机时间,支气管肺发育不良(BPD)发生率和28 d死亡率,并分析影响发生BPD的危险因素。结果 (1)出生后3 h内超声指导组PS使用率高于对照组,两组比较差异有统计学意义(χ2=9.069,P<0.05);超声指导组使用PS前最大FiO2值低于对照组,两组比较差异有统计学意义(t=11.213,P<0.05)。(2)超声指导组有创通气时间、氧疗时间均短于对照组,28 d内未使用呼吸机时间长于对照组,两组比较差异均有统计学意义(t=11.359、7.986、7.928,均P<0.05);两组CPAP时间比较,差异无统计学意义(t=0.622,P>0.05)。(3)超声指导组BPD发生率低于对照组,两组比较差异有统计学意义(χ2=4.754,P<0.05);两组28 d死亡率比较,差异无统计学意义(χ2=0.505,P>0.05)。(4)多因素Logistic回归分析显示,出生体重<1 500 g(OR=1.013)、机械通气使用时间长(OR=1.140)是导致BPD的危险因素;早期肺超声评估(OR=0.121)是预防BPD发生的保护性因素(P<0.05)。结论 采用LUS评分指导RDS早产儿早期应用PS能够提高PS使用率,减少机械通气和氧疗时间,降低BPD发生率,值得临床借鉴。

 Abstract:Objective To explore the value of lung ultrasound score (LUS) in guiding the early application of pulmonary surfactant (PS) to premature infants with respiratory distress syndrome (RDS). Methods Prospectively selected 184 premature infants with RDS admitted to the neonatal intensive care unit (NICU) of our hospital from March 2017 to April 2019. According to the random number table method, they were divided into ultrasound guidance group and control group, with 92 cases in each group. All premature infant were transferred to the NICU for continuous positive airway pressure (CPAP) after birth. The ultrasound-guided group underwent pulmonary ultrasound examination within 3 hours after birth. When the LUS score was >4 or FiO2>0.4, PS was given. In the control group, PS treatment was given only when FiO2>0.4; the first dose was 200 mg/kg, and if FiO2>0.4 after 12 hours, the second dose was 100 mg/kg. Observed the early PS usage rate and the maximum FiO2 value before PS use in the two groups; the continuous positive pressure ventilation time, invasive ventilation time, oxygen therapy time, the number of days without ventilator in 28 days, the incidence of bronchopulmonary dysplasia (BPD) and the 28-day mortality rate were compared and the risk factors affecting the occurrence of BPD were analyzed.  Results (1) The use rate of PS in the ultrasound-guided group was higher than that in the control group within 3 hours after birth, the difference between two groups was statistically significant (χ2=9.069,P<0.05); the FiO2 level in the ultrasound-guided group was lower than that in the control group when the first dose of PS was used, the difference between two groups was statistically significant (t=11.213, P<0.05). (2) Invasive ventilation time and oxygen therapy time in the ultrasound guidance group were lower than those in the control group, the differences between two groups were statistically significant (t=11.359, 7.986, 7.928,all P<0.05); the time of CPAP between group were compared and the difference was no statistically significant (t=0.622, P>0.05). (3) The incidence of BPD in the ultrasound-guided group was lower than that in the control group, and the difference was statistically significant (χ2=4.754, P<0.05); there was no statistically significant difference in 28 d mortality between the two groups (χ2=0.505,P>0.05). (4) Multivariate logistic regression analysis showed that birth weight <1 500g (OR=1.013) and mechanical ventilation time (OR=1.140) were the risk factors for the occurrence of BPD, early lung ultrasound evaluation (OR=0.121) was the protective factors for the occurrence of BPD (P<0.05). Conclusion The use of LUS to guide the early application of PS in premature infant with RDS can improve the use rate of PS, reduce the time of mechanical ventilation and oxygen therapy, and reduce the incidence of BPD, which is worthy of clinical reference.

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 参考文献

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