【摘要】 目的:探讨肺表面活性物质(PS)羊膜腔注射预防早产儿呼吸窘迫综合征(NRDS)的药代动力学机制及疗效。方法:(1)药代动力学研究。实验动物为妊娠25天的兔胎。将0.1ml PS注入羊膜腔内,分别于1h、2h、4h(Ⅰ组、Ⅱ组、Ⅲ组)娩出兔胎并处死;气管内给药PS 0.1ml或生理盐水0.1ml(Ⅳ组、对照组)后1h,娩出兔胎并处死。各组留取兔胎末端肺组织检测DPPC浓度。(2)临床研究:妊娠28～32周胎肺不成熟早产病例。随机分为3组:PS羊膜腔给药组,分娩前将固尔苏1支注入羊膜腔内;PS气管内给药组,新生儿娩出后立即将固尔苏1支经气管插管注入支气管内;对照组,出生前后不予PS预防性给药。结果:(1)药代动力学:Ⅰ组与Ⅳ组比较,兔胎肺组织中DPPC含量无明显差异[(1.133±0.402)mg/g肺组织vs(1.170±0.145)mg/g肺组织,P>0.05],两组均明显高于对照组[(0.684±0.158)mg/g肺组织,P均<0.01]。Ⅱ组、Ⅲ组兔胎肺组织中DPPC含量较Ⅰ组明显下降,与对照组的差异无统计学意义(P>0.05)。(2)临床研究:3组新生儿孕龄、出生体重无明显差异。PS羊膜腔给药组及PS气管内给药组新生儿NRDS发生率无明显差异(13.3%vs 14.3%,P>0.05),显著低于对照组(35%)(P均<0.05);两组持续正压通气的频率无明显差异(16.6%vs 22.8%,P>0.05),均显著低于对照组(57.5%)(P均<0.05)。新生儿住院时间PS羊膜腔给药组为(27.8±9.6)天,PS气管内给药组为(26.8±11.7)天,均显著短于对照组[(33.7±11.8)天](P均<0.05)。PS羊膜腔给药组及气管内给药组新生儿均存活,对照组死亡4例。结论:PS羊膜腔给药可显著降低早产儿NRDS发生率并改善预后,可取得和气管内给药一样的效果,临床应用风险小,操作简单,值得临床推广应用。更多还原

【Abstract】 Objective:To study the pharmacokinetic mechanism and clinical effect of pulmonary surfactant administrated by amniotic injection to prevent respiratory distress in preterm newborns.Methods:The pregnant rabbit fetus in 25d gestation was devided into 5 groups:0.1ml PS was injected into amniotic fluid,and the rabbit fetus was delivered by cesarean in 1h,2h,4h(group Ⅰ,Ⅱ,Ⅲ).0.1ml PS or saline was adminstrated by tracheal and observed in 1h(group Ⅳ,controls).The concentration of DPPC in the rabbit fetus lung tissues was tested.Clinical research:the preterm labor cases in 28~32 weeks gestation was devided into 3 group.In the amniotic group,2ml curosurf was injected into amniotic fluid before delivered.In tracheal group,2ml curosurg was administrated by tracheal.In the control group,no PS was administrated.Results:(1)There was no difference between the groupⅠ and groupⅢ(P>0.05),but each of the group was significantly higher than control(P<0.01).There was no difference between group Ⅱ or group Ⅲ and control(P>0.05).(2)The rate of NRDS and CPAP was no difference between amniotic group and tracheal group,each of the group was significally lower than those of the control group(P<0.05).All the infants in amniotic group and tracheal group were alive.4 deaths in control group.The in-patient time in amniotic group was 27.8±9.6d,and 26.8±11.7d in tracheal group(P>0.05),but all much shorter than the control group(P<0.05).Conclusion:PS administrated by amniotic is as effective as by tracheally to prevent NRDS of preterm neonates,but the risk is lower and much simple than the later.更多还原