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目的探讨肺表面活性物质(PS)对不同胎龄儿呼吸窘迫综合征(RDS)的疗效差异。方法选择胎龄28~39周,出生体质量760~3 240 g,经PS治疗的RDS患儿67例。早期组:胎龄28~30周的早期早产儿18例;中期组:胎龄31~33周的中期早产儿28例;晚期组:胎龄34周以上的晚期早产儿和足月儿21例。比较3组PS治疗时RDS的重症程度、PS开始使用时间、第1次使用剂量、总剂量、重复使用例数、氧疗时间、最高吸氧体积分数(FiO2)、机械通气时间等指标。结果 PS治疗时早期组和中期组轻度RDS例数明显多于晚期组(Pa<0.05)。中期组和晚期组重度RDS例数明显多于早期组(Pa<0.05),PS开始使用时间晚期组明显晚于早、中期组(Pa<0.05)。第1次使用剂量早期组明显多于中、晚期组(Pa<0.05)。使用总剂量和重复使用例数各组间均无统计学差异(Pa>0.05)。机械通气时间早、晚期组明显多于中期组(P=0.040);最高FiO2以晚期组最高(P=0.006)。结论早期早产儿RDS病情轻、开始PS治疗时间早、剂量足,但需氧疗和机械通气时间长;晚期早产儿和足月儿RDS病情危重、开始PS治疗时间晚、剂量不足、需氧疗和机械通气时间长。对晚期早产儿和足月儿RDS治疗应尽早、足量使用PS。
Objective To investigate the effect of pulmonary surfactant (PS) on respiratory distress syndrome (RDS) in different gestational age children. Methods The gestational age ranged from 28 to 39 weeks, and the birth weight ranged from 760 to 3 240 g. There were 67 RDS children treated with PS. In the early group, there were 18 early gestational age in the 28-30 week gestational age group; in the midterm group, there were 28 middle term preterm children in the gestational age range 31-33 weeks; in the late group, late preterm and gestational age children more than 34 weeks gestational age were 21 . The severity of RDS, PS start time, the first dose, the total dose, the number of repeated use cases, the oxygen therapy time, the maximum oxygen inhalation volume fraction (FiO2) and the time of mechanical ventilation were compared among the three PS treatment groups. Results There were more cases of mild RDS in early stage and mid stage than those in advanced stage (P <0.05). The number of severe RDS in the intermediate group and the late group was significantly higher than that in the early group (P <0.05). The late onset group was significantly later than the early and middle groups (Pa <0.05). The first dose of the early group was significantly more than the group, the late group (Pa <0.05). There was no significant difference in the total dose and the number of repeated use among the groups (Pa> 0.05). The time of mechanical ventilation was earlier in the late group than that in the intermediate group (P = 0.040). The highest FiO2 was the highest in the late group (P = 0.006). Conclusions RDS is mild in early preterm infants, PS is early and dose is adequate, but aerobic and mechanical ventilation are prolonged; late preterm and term infants with RDS are in critical condition, PS is started late, hypodermic, aerobic And mechanical ventilation for a long time. RDS treatment of late preterm children and term infants should be as early as possible, adequate use of PS.