【摘要】 目的探讨预防性应用牛肺表面活性物质对胎龄<32周早产儿病死率和主要并发症发生率的影响。方法 2012年10月至2013年9月在国内9家医院进行多中心临床对照研究,研究对象为胎龄<32周的早产儿,分为预防组(生后30分钟内给药)和早期治疗组(出生后2小时内给药),均气管插管内滴入国产牛肺表面活性剂(70mg/kg)。比较两组患儿的呼吸窘迫综合征(respiratory distress syndrome,RDS)发生率、病死率和主要并发症发生率等指标。结果共纳入有效病例预防组116例,早期治疗组91例。预防组RDS的发生率略高于早期治疗组,但差异无显著性(P>0.05),重度RDS的发生率明显低于早期治疗组,差异具有显著性(P<0.05)。预防组患儿中至重度支气管肺发育不良(bronchopulmonary dysplasia,BPD)和动脉导管未闭(patent ductus arteriosus,PDA)的发生率明显低于早期治疗组,差异具有显著性(P均<0.05),重度脑室内出血(intraventricular hemorrhage,IVH)、中至重度坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、气漏、肺出血及败血症的发生率预防组和早期治疗组比较差异均无显著性(P均>0.05)。结论对于胎龄<32周的早产儿,预防性应用肺表面活性物质可以降低重度RDS、中至重度BPD和PDA的发生风险。更多还原

【Abstract】 Objective To evaluate whether prophylactic bovine surfactant administration is superior to early selective treatment in gestational age<32 weeks preterm infants with high risk of RDS. Method Multi center and clinical control study was carried in 9 domestic hospitals from October 2012 to September 2013, which research object was gestational age < 32 weeks premature. All of them were divided into prevention group(born after 30 minutes in dosing) and early treatment group(administered within 2 hours after birth), and treated by tracheal intubation drip into the domestic bovine pulmonary surface active agent(70mg/kg). The incidence rate, mortality rate and major complication incidence of respiratory distress syndrome(RDS) were compared between the two groups. Result A total of 116 cases were included in the effective prevention group and 91 cases in the early treatment group. The incidence of RDS in the prevention group was slightly higher than that in the early treatment group, but there was no significant difference between the two groups. The prophylactic groups had a significantly lower incidence of severe RDS and significantly lower rate of repeated doses of surfactant than the early treatment group(P both <0.05). The incidences of moderate to severe BPD and PDA were lower in the prophylactic group than the early treatment group(P<0.05).There was no significant difference in neonatal mortality and major morbidities such as severe IVH, NEC, air leaks, pulmonary hemorrhage and sepsis between two groups(P all>0.05). Conclusion In preterm infants less than 32 weeks’ gestation, prophylactic use of a domestic surfactant preparation is better than early treatment in decreasing the incidence of severe RDS, moderate to severe BPD and PDA.更多还原