極早產兒重復實施微創肺表面活性物質治療的近期臨床結局研究

［摘 要］目的 評估重復實施微創肺表面活性物質治療（MIST）對極早產兒近期臨床結局的影響。方法 選擇2016年1月至2022年11月于揚州大學醫學院附屬鹽城婦幼保健院分娩、實施二劑肺表面活性物質（PS）治療且首劑給藥方式為MIST的183例極早產兒為研究對象。根據第二劑PS給藥方式不同，分為重復MIST組（rMIST組，n=112）和氣管插管組（ETT組，n=71）。分析比較兩組極早產兒及其母親的臨床資料及相關預后指標，并采用多因素Logistic回歸分析rMIST與支氣管肺發育不良（BPD）發生的相關性。結果 rMIST組患兒第二劑PS前最高吸入氧濃度（FiO2）低于ETT組，首劑與第二劑PS應用間隔時間長于ETT組，差異有統計學意義（t值分別為3.779、4.115，Plt;0.05）；rMIST組機械通氣比率、通氣時間和BPD發生率低于ETT組，差異有統計學意義（t/χ2值分別為4.825、1.599、4.546，Plt;0.05）；多因素Logistic回歸分析顯示rMIST為BPD發生的保護因素，使用機械通氣和通氣時間較長為BPD發生的危險因素，其aOR值及95%CI分別為0.863（0.162～0.913）、2.002（1.114～4.116）、2.058（1.011～5.026）。結論 對極早產兒重復實施MIST，可降低其機械通氣的比率，可能會降低其BPD的發生率。

［關鍵詞］微創肺表面活性物質治療；支氣管肺發育不良；早產兒；臨床結局

Doi：10.3969/j.issn.1673-5293.2024.09.009

［中圖分類號］R174.1""" ［文獻標識碼］A

［文章編號］1673-5293（2024）09-0057-07

Short-term clinical outcome of repeated minimally invasive surfactant therapy in very premature infants

［Abstract］ Objective To evaluate short-term clinical outcome of repeated minimally invasive surfactant therapy （rMIST） in very （extremely） premature infants. Methods 183 extremely premature infants who gave birth，received two doses of pulmonary surfactant （PS） treatment and received the first dose of PS by MIST in The Affiliated Yancheng Maternal and Child Health Hospital of Yangzhou University from January 2016 to November 2022 were selected as study subjects.According to administration method of the second dose of PS，they were divided into repeated MIST group （rMIST group） and endotracheal intubation group （ETT group）.The clinical data and prognostic indexes of very premature infants and their mothers in the two groups were analyzed and compared.Independent sample t-test or continuity-adjusted Chi-square test were used for statistical analysis，and multifactorial Logistic regression was used to analyze correlation between rMIST and bronchopulmonary dysplasia （BPD）. Results The maximum fraction of inspired oxygen （FiO2） before PS in the rMIST group was significantly lower than that in the ETT group，and the interval between the first and the second doses of PS was significantly longer than that in the ETT group （t=3.779 and 4.115 respectively，both Plt;0.05）.The mechanical ventilation rate，ventilation time and the incidence of BPD in the rMIST group were significantly lower than those in the ETT group，and the differences were significant （t/χ2=4.825，1.599 and 4.546 respectively，all Plt;0.05）.Multifactorial Logistic regression analysis showed that repeated MIST （aOR=0.863，95%CI：0.162-0.913） was protective factor of BPD，while utility of mechanical ventilation （aOR=2.002，95%CI：1.114-4.116） and mechanical ventilation time （aOR=2.058，95%CI：1.011-5.026） were risk factors for BPD. Conclusion Repeated implementation of MIST on extremely premature infants can reduce rate of mechanical ventilation and may reduce the incidence of BPD.

［Key words］ repeated minimally invasive surfactant therapy;pulmonary surfactant;bronchopulmonary dysplasia;premature infant;clinical outcome

無創呼吸支持如經鼻持續氣道正壓通氣（nasal continuous positive airway pressure ventilation，nCPAP），已成為早產兒呼吸功能不全的常規治療方法［1］。然而，由于早產兒肺表面活性物質（pulmonary surfactant，PS）缺乏，經常因并發嚴重呼吸窘迫綜合征（respiratory distress syndrome，RDS）而導致nCPAP治療失敗［2］。近年來，微創肺表面活性物質治療（minimally invasive surfactant therapy，MIST）等新給藥方式的出現，結合無創呼吸支持，降低了有創機械通氣的使用率［3-4］。有Meta分析表明，MIST降低了早產兒生后72h內有創機械……