探讨不同时间给予肺表面活性物质(PS)，对早产儿呼吸窘迫综合征(RDS)的治疗效果及结局差异。

选择2014年10月至2015年10月，广西壮族自治区妇幼保健院新生儿重症监护病房收治的60例RDS早产儿为研究对象。根据PS使用时间，将患儿分为早期组(n＝32，生后2 h内使用)和晚期组(n＝28，生后2～12 h使用)。统计学比较2组早产儿一般临床资料，PS治疗前及治疗后6、24、48 h血气分析及肺氧合功能指标，治疗时间及并发症发生情况。本研究遵循的程序经广西壮族自治区妇幼保健院伦理委员会批准，并与使用PS治疗的患儿家属签署使用知情同意书。

①2组早产儿中男性患儿比例、出生胎龄、出生体重、产妇产前使用激素比例、呼吸评分、氧合指数(OI)，以及RDS患儿胸部X射线摄片分级为Ⅱ级及Ⅲ级所占比例比较，差异均无统计学意义(P>0.05)。②组内比较结果：早期组早产儿PS治疗后6、24、48 h的血气分析结果，包括血液pH值，动脉血氧分压(PaO₂)及动脉血二氧化碳分压(PaCO₂)，以及肺氧合功能指标，如动脉-肺泡氧分压比值(a/APO₂)和OI，均分别较本组早产儿治疗前显著改善。除PaCO₂外，晚期组早产儿PS治疗后6、24、48 h的其余血气分析结果和肺氧合功能指标，亦均分别较本组早产儿治疗前显著改善，并且上述差异均有统计学意义(P<0.05)。③组间比较结果：早期组早产儿PS治疗后6、24、48 h的血液pH值、PaO₂、PaCO₂、a/APO₂及OI改善情况，均优于晚期组相应时间点，并且差异均有统计学意义(P<0.05)。④早期组早产儿有创及无创机械通气时间、氧疗时间及住院时间，均显著短于晚期组早产儿，并且差异均有统计学意义(P<0.05)。⑤早期组早产儿支气管肺发育不良(BPD)、颅内出血(ICH)及早产儿视网膜病(ROP)发生率，均较晚期组低，并且差异均有统计学意义(P<0.05)。

生后2 h内应用PS，能更好改善RDS早产儿的肺通气和氧合功能，减少治疗时间和并发症发生。

To discuss therapeutical effect and different outcomes of using pulmonary surfactant(PS) at different time for treatment of premature infant respiratory distress syndrome(RDS).

A total of 60 RDS premature infants who were born from October 2014 to October 2015, and admitted to neonatal intensive care unit in the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, were chosen as study subjects. According to PS using time, they were divided into early group(n=32, using PS within 2 h after birth) and late group(n=28, using PS within 2-12 h after birth). Statistically compared the differences between two groups of RDS premature infants, including general clinical data, blood gas analysis and the pulmonary oxygenation function index before using PS and 6, 24, 48 h after using PS, therapeutical time and complications. This research was approved by the Ethics Committee of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, and the parents of RDS premature infants signed the informed consents of using PS.

①There were no significant differences between two groups of RDS premature infants in male rate, gestational age at birth, birth weight, prenatal corticosteroids using rate of puerpera, breathing score, oxygenation index(OI), ratio of Ⅱ and Ⅲ stages lesion of chest X ray of RDS premature infants (P>0.05). ②Intra group comparison results within early group or late group showed that the blood gas analysis of pH values, partial pressure of oxygen in artery (PaO₂), partial pressure of carbon dioxide in artery (PaCO₂), and pulmonary oxygenation function index of arterial and alveolar oxygen partial pressure ratio (a/APO₂) and OI after using the PS treatment at 6, 24, 48 h of RDS premature infants were all improved compared to those of before treatment, and all the differences above were statistically significant (P<0.05), except for PaCO₂ in late group (P>0.05). ③Results between early group and late group showed that the improvement of pH values of blood, PaO₂, PaCO₂, a/APO₂ and OI after using the PS treatment at 6, 24, 48 h of RDS prematurein fants in early group were better than those of late group at the same time points, and all the differences were statistically significant (P<0.05). ④The durations of using invasive and noninvasive mechanical ventilation, oxygen therapy and hospitalization of RDS premature infants in early group were all shorter than those of late group, and all the differences were statistically significant (P<0.05). ⑤The incidence rates of bronchial pulmonary dysplasia (BPD), intracranial hemorrhage (ICH) and retinopathy of prematurity (ROP) of RDS premature infants in early group were lower than those of late group, and all the differences were statistically significant(P<0.05).

Application of PS within 2 h after birth can improve the lung ventilation and oxygenation function for RDS premature infants, and reduce the therapeutic time and the occurrence of complications.