摘要目的 探讨肺泡表面活性物质(PS)与布地奈德二联支气管药物滴注方案对重症呼吸窘迫综合征(RDS)早产儿临床预后的影响.方法 选取河北省邯郸市中心医院2016年1月至2018年3月收治的重症RDS早产儿患儿128例,按随机数字表法分为对照组(64例)和试验组(64例),对照组给予单用PS支气管滴注,试验组给予PS联合布地奈德支气管内滴注;比较两组有创机械通气时间、呼吸机撤除时间、住院总时间、治疗前后血氧指标水平及并发症发生率.结果 试验组有创机械通气时间、呼吸机撤除时间及住院总时间均显著短于对照组[(3.50 ± 0.72)d比(4.84 ± 0.98)d,(29.52 ± 3.97)d比(35.21 ± 5.10)d,(45.26 ± 6.27)d比(53.85 ± 8.04)d],差异有统计学意义(P＜0.05);试验组治疗后血氧指标水平均显著优于对照组(P＜0.05).两组总支气管肺发育不良(BPD)、视网膜病变、坏死性小肠结肠炎、肺出血、败血症、颅内出血及呼吸机相关性肺炎发生率比较差异无统计学意义(P＞0.05).试验组中重度BPD发生率显著低于对照组[15.63% (10/64)比45.31%(29/64)],差异有统计学意义(P＜0.05).结论 二联支气管药物滴注方案用于重症RDS早产儿治疗能够加快病情康复,改善肺部通气功能,并有助于预防中重度BPD出现.

abstractsObjective To investigate the influence of combined drug therapy by intratracheal infusion on clinical prognosis of premature infants with severe respiratory distress syndrome (RDS). Methods One hundred and twenty-eight premature infants with severe RDS were chosen in the period from August 2015 to December 2017 in central hospital of Hebei Handan and randomly divided into 2 groups including control group (64 children) treated with pulmonary surfactant (PS) by intratracheal infusion and experimental group (64 children) treated with PS and budesonide by intratracheal infusion. The invasive ventilation time, withdrawal time, total hospitalization time, the levels of blood oxygen index before and after treatment and the complications incidence of two groups were compared. Results The invasive ventilation time, withdrawal time and total hospitalization time in experimental group were significantly shorter than those in control group: (3.50 ± 0.72) d vs.(4.84 ± 0.98) d, (29.52 ± 3.97) d vs. (35.21 ± 5.10) d, (45.26 ± 6.27) d vs. (53.85 ± 8.04) d, and there were significant differences (P<0.05). The levels of blood oxygen index after treatment of experimental group were significantly better than those of control group (P < 0.05). The incidence of total bronchopulmonary dysplasia(BPD), retinopathy, necrotizing enterocolitis, pulmonary hemorrhage, sepsis, intracranial hemorrhage and ventilator-associated pneumonia (VAP) in two groups had not significant differences (P>0.05). But the moderate to severe BPD in experimental group was significantly lower than that in control group: 15.63%(10/64) vs. 45.31% (29/64), P < 0.05. Conclusions Combinated drug therapy by intratracheal infusion in the treatment of premature infants with severe RDS can efficiently promote disease recovery process, improve the lung function and be helpful to prevent the moderate and severe degree BPD.