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目的探讨肺表面活性物质(PS)联合布地奈德对急性呼吸窘迫综合征(ARDS)极低出生体质量儿肺功能的影响,并评价联合用药的治疗效果。方法 2010年8月-2011年3月南京市妇幼保健院收治的胎龄<34周、出生体质量<1 500 g、出生4 h内发生ARDS的早产儿30例,随机分为PS组和PS+布地奈德组。PS+布地奈德组(男9例,女6例)使用PS和布地奈德混合剂(每70 mg PS中加入0.25 mg布地奈德),剂量:PS 70 mg.kg-1,布地奈德0.25 mg.kg-1。PS组(男8例,女7例)单使用PS,70 mg.kg-1,出生30～60 min内由气管内滴入。监测2组患儿血气及肺功能。结果 PS+布地奈德组患儿动脉血气pH值第2、5、6天明显高于PS组(Pa<0.05),二氧化碳分压[pa(CO2)]第3、4、6天明显降低(Pa<0.05),氧合指数(OI)第3、4、6天明显升高(Pa<0.05);肺功能监测2组胸肺总顺应性(Crs)升高、呼吸道阻力(Raw)下降、潮气量(TV)增加,第5、6天与PS组比较有显著差异(Pa<0.05)。结论使用PS联合布地奈德对ARDS极低出生体质量儿能较快改善肺功能,尽早撤离呼吸机,减少肺损伤,减少早产儿支气管肺发育不良的发生。
Objective To investigate the effects of pulmonary surfactant (PS) combined with budesonide on lung function of children with acute respiratory distress syndrome (ARDS) with very low birth weight and to evaluate the therapeutic effect of combination therapy. Methods From August 2010 to March 2011, 30 pregnant women with gestational age <34 weeks, birth weight <1 500 g and ARDS within 4 h after birth were randomly divided into PS group and PS + Budesonide group. The PS + budesonide group (9 males and 6 females) was treated with PS and budesonide (0.25 mg budesonide per 70 mg PS) at doses of 70 mg.kg-1 PS, budesonide 0.25 mg.kg-1. PS group (8 males and 7 females) were given PS, 70 mg.kg-1, and were intratracheally instilled within 30-60 minutes after birth. Blood gas and lung function were monitored in two groups. Results The arterial blood gas pH values in PS + budesonide group were significantly higher than those in PS group on day 2, 5 and 6 (P <0.05), and Pa (CO2) (P <0.05). Oxygenation index (OI) increased significantly (P <0.05) on the 3rd, 4th, 6th day in lung function monitoring group. The pulmonary thoracic lung compliance (Crs), airway resistance (TV) increased, there was a significant difference (P <0.05) between the 5th and 5th day compared with the PS group. Conclusions PS combined with budesonide can improve pulmonary function in ARDS patients with very low birth weight, evacuate ventilator as early as possible, reduce lung injury and reduce the incidence of bronchopulmonary dysplasia in preterm infants.