Comparison of curative effects of using pulmonary surfactant at different time in treatment of premature infants with respiratory distress syndrome

doi:10.3877/cma.j.issn.1673-5250.2017.04.015

Objective

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

Methods

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.

Results

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).

Conclusions

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.

Key words: Pulmonary surfactants, Respiratory distress syndrome, newborn, Calf pulmonary surfactant for injection, Infant, premature

表1 2组早产儿一般临床资料比较

组别	例数	男性早产儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	母亲产前使用激素[例数(%)]	呼吸评分(分，±s)	OI(mmHg，±s)	RDS的胸部X射线摄片结果[例数(%)]
组别	例数	男性早产儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	母亲产前使用激素[例数(%)]	呼吸评分(分，±s)	OI(mmHg，±s)	Ⅱ级	Ⅲ级
早期组	32	18(5.6)	30.3±1.9	1 241±231	25(7.8)	5.7±1.3	12.4±5.2	12(37.5)	7(21.9)
晚期组	28	16(5.7)	31.9±2.4	1 062±311	24(8.6)	6.8±2.2	12.0±7.1	10(35.7)	6(21.4)
检验值	?	χ²＝1.640	t＝134.810	t＝43.840	χ²＝0.093	t＝3.642	t＝9.645	χ²＝1.956	χ²＝1.834
P值	?	0.940	0.098	0.477	0.448	0.682	0.607	0.703	0.891

表1 2组早产儿一般临床资料比较

组别	例数	男性早产儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	母亲产前使用激素[例数(%)]	呼吸评分(分，±s)	OI(mmHg，±s)	RDS的胸部X射线摄片结果[例数(%)]
组别	例数	男性早产儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	母亲产前使用激素[例数(%)]	呼吸评分(分，±s)	OI(mmHg，±s)	Ⅱ级	Ⅲ级
早期组	32	18(5.6)	30.3±1.9	1 241±231	25(7.8)	5.7±1.3	12.4±5.2	12(37.5)	7(21.9)
晚期组	28	16(5.7)	31.9±2.4	1 062±311	24(8.6)	6.8±2.2	12.0±7.1	10(35.7)	6(21.4)
检验值	?	χ²＝1.640	t＝134.810	t＝43.840	χ²＝0.093	t＝3.642	t＝9.645	χ²＝1.956	χ²＝1.834
P值	?	0.940	0.098	0.477	0.448	0.682	0.607	0.703	0.891

表2 2组早产儿肺表面活性物质治疗前及治疗后不同时间点血气分析及肺氧合功能指标组内及组间比较(±s)

组别	例数	血液pH值				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	7.13±0.07	7.35±0.05	7.32±0.02	7.33±0.03	12.657	0.033
晚期组	28	7.15±0.09	7.28±0.07	7.26±0.04	7.26±0.06	9.648	0.049
t值	?	11.637	25.943	29.749	23.571	?	?
P值	?	0.843	0.036	0.034	0.047	?	?
组别	例数	PaO₂(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	48.2±16.3	93.4±35.0	82.7±27.7	84.0±29.6	125.934	0.037
晚期组	28	45.1±15.5	84.7±29.4	72.9±25.4	74.4±27.2	98.426	0.039
t值	?	36.459	79.245	91.637	90.374	?	?
P值	?	0.761	0.044	0.028	0.030	?	?
组别	例数	PaCO₂(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	54.5±16.6	42.7±12.5	36.9±10.9	34.8±11.5	25.618	0.042
晚期组	28	55.8±15.3	52.4±12.9	49.1±11.7	48.1±10.6	12.452	0.067
t值	?	19.412	56.943	39.497	79.618	?	?
P值	?	0.943	0.032	0.043	0.027	?	?
组别	例数	a/APO₂				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	0.15±0.06	0.32±0.20	0.43±0.22	0.47±0.19	9.364	0.039
晚期组	28	0.13±0.04	0.27±0.14	0.35±0.18	0.41±0.16	7.642	0.042
t值	?	1.587	5.953	7.319	6.843	?	?
P值	?	0.584	0.040	0.031	0.035	?	?
组别	例数	OI(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	12.4±5.2	5.9±2.8	4.9±2.7	3.9±2.9	6.267	0.036
晚期组	28	12.0±7.1	7.7±3.6	5.3±2.4	4.1±2.6	4.129	0.042
t值	?	1.357	11.329	6.216	4.297	?	?
P值	?	0.627	0.041	0.045	0.049	?	?

表2 2组早产儿肺表面活性物质治疗前及治疗后不同时间点血气分析及肺氧合功能指标组内及组间比较(±s)

组别	例数	血液pH值				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	7.13±0.07	7.35±0.05	7.32±0.02	7.33±0.03	12.657	0.033
晚期组	28	7.15±0.09	7.28±0.07	7.26±0.04	7.26±0.06	9.648	0.049
t值	?	11.637	25.943	29.749	23.571	?	?
P值	?	0.843	0.036	0.034	0.047	?	?
组别	例数	PaO₂(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	48.2±16.3	93.4±35.0	82.7±27.7	84.0±29.6	125.934	0.037
晚期组	28	45.1±15.5	84.7±29.4	72.9±25.4	74.4±27.2	98.426	0.039
t值	?	36.459	79.245	91.637	90.374	?	?
P值	?	0.761	0.044	0.028	0.030	?	?
组别	例数	PaCO₂(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	54.5±16.6	42.7±12.5	36.9±10.9	34.8±11.5	25.618	0.042
晚期组	28	55.8±15.3	52.4±12.9	49.1±11.7	48.1±10.6	12.452	0.067
t值	?	19.412	56.943	39.497	79.618	?	?
P值	?	0.943	0.032	0.043	0.027	?	?
组别	例数	a/APO₂				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	0.15±0.06	0.32±0.20	0.43±0.22	0.47±0.19	9.364	0.039
晚期组	28	0.13±0.04	0.27±0.14	0.35±0.18	0.41±0.16	7.642	0.042
t值	?	1.587	5.953	7.319	6.843	?	?
P值	?	0.584	0.040	0.031	0.035	?	?
组别	例数	OI(mmHg)				F值	P值
组别	例数	治疗前	治疗后6 h	治疗后24 h	治疗后48 h	F值	P值
早期组	32	12.4±5.2	5.9±2.8	4.9±2.7	3.9±2.9	6.267	0.036
晚期组	28	12.0±7.1	7.7±3.6	5.3±2.4	4.1±2.6	4.129	0.042
t值	?	1.357	11.329	6.216	4.297	?	?
P值	?	0.627	0.041	0.045	0.049	?	?

表3 2组早产儿相关治疗时间比较(d，±s)

组别	例数	有创机械通气时间	无创机械通气时间	氧疗时间	住院时间
早期组	32	3.6±1.0	5.9±2.7	9.5±2.6	17.7±5.0
晚期组	28	8.2±2.0	10.7±1.9	14.1±3.1	26.3±6.8
t值	?	4.957	4.291	6.192	7.811
P值	?	0.026	0.019	0.004	<0.001

表3 2组早产儿相关治疗时间比较(d，±s)

组别	例数	有创机械通气时间	无创机械通气时间	氧疗时间	住院时间
早期组	32	3.6±1.0	5.9±2.7	9.5±2.6	17.7±5.0
晚期组	28	8.2±2.0	10.7±1.9	14.1±3.1	26.3±6.8
t值	?	4.957	4.291	6.192	7.811
P值	?	0.026	0.019	0.004	<0.001

表4 2组早产儿并发症发生情况比较[例数(%)]

组别	例数	肺部感染	BPD	ICH	肺出血	气胸	ROP	新生儿坏死性小肠结肠炎
早期组	32	5(15.6)	10(31.2)	7(21.9)	3(9.4)	2(6.3)	2(6.3)	2(6.3)
晚期组	28	3(10.7)	11(39.3)	8(28.6)	1(3.6)	1(3.6)	3(10.7)	1(3.6)
χ²值	?	3.606	4.000	4.290	0.576	0.268	4.320	0.218
P值	?	0.065	0.045	0.038	0.447	0.605	0.042	0.640

表4 2组早产儿并发症发生情况比较[例数(%)]

组别	例数	肺部感染	BPD	ICH	肺出血	气胸	ROP	新生儿坏死性小肠结肠炎
早期组	32	5(15.6)	10(31.2)	7(21.9)	3(9.4)	2(6.3)	2(6.3)	2(6.3)
晚期组	28	3(10.7)	11(39.3)	8(28.6)	1(3.6)	1(3.6)	3(10.7)	1(3.6)
χ²值	?	3.606	4.000	4.290	0.576	0.268	4.320	0.218
P值	?	0.065	0.045	0.038	0.447	0.605	0.042	0.640

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