摘要目的 探讨布地奈德联合猪肺磷脂注射液(肺泡表面活性物质,PS)预防早产儿支气管肺发育不良(BPD)的效果.方法 选取2013年10月至2015年2月于出生6h内在西南医科大学附属医院新生儿科住院治疗的早产儿120例,胎龄≤32周,出生体质量≤1500g,分为4组,每组30例,分别为A组:对照组;B组:新生儿呼吸窘迫综合征(NRDS)组;C组:NRDS+PS组;D组:NRDS+PS+布地奈德组.A组除早产外无其他特殊疾病,且出生48h内未吸氧;B组持续无创呼吸机辅助通气(吸氧持续时间≥48h,吸氧体积分数≥400mL/L);C组在B组基础上在出生6h内予气管插管滴入PS100mg/kg;D组在C组基础上再滴入吸入用布地奈德混悬液0.25mg/kg.观察用药前后血气分析中pH、动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]情况,是否改为有创呼吸机辅助通气,高氧使用持续时间,总吸氧时间,再次使用PS率,BPD发生率及总住院天数.并观察各组不良反应:高血压、高血糖、坏死性小肠结肠炎及院内感染发生率.结果 C组与B组比较,用药后1、6hpH,1、6、12h pa(O2)及pa(CO2)值明显改善,差异均有统计学意义(P均＜0.01);D组与B组比较,以上指标改善更明显,差异均有统计学意义(P均＜0.01);与B组比较,其余3组高氧持续时间、总吸氧时间、改为有创呼吸率、再次使用PS率及BPD发生率均明显减少,差异均有统计学意义(P均＜0.05);C、D组BPD发生率比较差异有统计学意义(10.00％比3.33％,x2 =4.00,P=0.046);各组间总住院天数及不良反应发生率比较差异均无统计学意义(P均＞0.05).结论 布地奈德联合猪肺磷脂注射液能够有效预防BPD的发生,且优于单纯使用猪肺磷脂注射液,不良反应发生率未见明显增加.

abstractsObjective To evaluate the effect of Budesonide combined with Poractant Alfa(pulmonary surfactants,PS) on preventing the bronchopulmonary dysplasia (BPD) in preterm infants.Methods One hundred and twenty preterm infants 6 hours after birth(gestational ages≤32 weeks and birth weights ≤1500 g)admitted to the Department of Newborn Medicine,the Affiliated Hospital of Southeast Medical University from October 2013 to February 2015 were randomly divided into 4 group(30 cases in each group).Group A was a control group,group B was neonatal respiratory distress syndrome(NRDS) group,group C was NRDS with PS group,and group D was NRDS with PS and Budesonide group.Thirty-two-week preterms without other diseases and without uptaking oxygen within 48 h were assigned as group A.Group B were treated by continuous uptaking oxygen with continuous positive airway pressure(CPAP) (oxygen uptaken lasting more than 48 h and oxygen concentrations more than 40％).Group C were treated with 100 mg/kg PS within 48 h on the basis of group B.Group D were treated with 0.25 mg/kg Budesonide suspension for inhalation on the basis of group C.The pH value,partial pressure of oxygen [pa(O2)],partial pressure of carbon dioxide [pa(CO2)] in the blood gas analysis were all detected in all groups before treatment,1,6,12,24 and 48 hours after using drug,respectively.All groups were also observed for whether to use respirator assisted ventilation,the duration of high oxygen use,the total time of uptaking oxygen,the rate of using PS again,the rate of BPD,the total hospitalization days and the adverse effects.The adverse effects included high blood pressure,high blood sugar,necrotizing enterocolitis and the incidence of nosocomial infection.Results Compared with group B,the pH value at 1 and 6 hours after using drugs,the pa(O2) and pa(CO2) at 1,6 and 12 hours after using drugs were improved obviously in the group C,and the differences were statistically significant (all P＜0.01).Compared with group B,the above indicators were improved more obvious in group D,and the differences were statistically significant (all P＜0.01).Moreover,compared with the group B,the oxygen inhalation duration,the rate of having a respirator assisted ventilation and using PS again,and the incidence of BPD were obviously decreased in other groups,the differences were statistically significant (all P＜0.05).The incidence of BPD in group D was less than that of group C,and the differences were statistically significant (3.33％ vs 10.00％,x2=4.00,P=0.046).The total oxygen time and the rate of adverse effects of each group were similar.The differences were not statistically significant (all P＞0.05).Conclusions Budesonide combined with Poractant Alfa can prevent BPD in preterm infants.Its effect is better than the simple use of Poractant Alfa,and the rate of adverse effects are not increased significantly.