极早产儿重复实施微创肺表面活性物质治疗的近期临床结局研究

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

摘要

目的 评估重复实施微创肺表面活性物质治疗(MIST)对极早产儿近期临床结局的影响。方法 选择2016年1月至2022年11月于扬州大学医学院附属盐城妇幼保健院分娩、实施二剂肺表面活性物质(PS)治疗且首剂给药方式为MIST的183例极早产儿为研究对象.根据第二剂PS给药方式不同,分为重复MIST组(rMIST组,n=112)和气管插管组(ETT组,n=71).分析比较两组极早产儿及其母亲的临床资料及相关预后指标,并采用多因素Logistic回归分析rMIST与支气管肺发育不良(BPD)发生的相关性。结果 rMIST组患儿第二剂PS前最高吸入氧浓度(FiO₂)低于ETT组,首剂与第二剂PS应用间隔时间长于ETT组,差异有统计学意义(t值分别为3.779、4.115,P<0.05);rMIST组机械通气比率、通气时间和BPD发生率低于ETT组,差异有统计学意义(t/χ²值分别为4.825、1.599、4.546,P<0.05);多因素Logistic回归分析显示rMIST为BPD发生的保护因素,使用机械通气和通气时间较长为BPD发生的危险因素,其aOR值及95%CI分别为0.863(0.162~0.913)、2.002(1.114~4.116)、2.058(1.011~5.026)。结论 对极早产儿重复实施MIST,可降低其机械通气的比率,可能会降低其BPD的发生率.

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 P<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 P<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.

关键词

微创肺表面活性物质治疗 / 支气管肺发育不良 / 早产儿 / 临床结局

Key words

repeated minimally invasive surfactant therapy / pulmonary surfactant / bronchopulmonary dysplasia / premature infant / clinical outcome

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基金资助

盐城市医学科技发展计划重点资助项目(YK2021005)

盐城市重点研发计划(社会发展)项目(YCBE202206)

盐城市卫健委2023年度医学科研面上项目(YK2023083)