Dani Carlo, Corsini Iuri, Bertini Giovanna, Fontanelli Giulia, Pratesi Simone, Rubaltelli Firmino F
Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Viale Morgagni, 85, 50134 Florence, Italy.
J Matern Fetal Neonatal Med. 2010 Sep;23(9):1024-9. doi: 10.3109/14767050903572174.
Our aim was to identify the clinical characteristics which could distinguish infants who can be managed with INSURE (intubatio-surfactant-extubation) method for preventing mechanical ventilation (MV) and which could predict INSURE success or failure.
Inborn infants with gestational age <30 weeks were Infants were categorised into three groups: (1) infants who needed MV in the delivery room; (2) infants spontaneously breathing who were treated only with NCPAP; (3) infants who were treated with INSURE method.
We studied 125 infants: 30 (24%) required MV, 75 (60%) received INSURE treatment, and 20 (16%) were treated with NCPAP. Sixty-eight (91%) infants were successfully treated with the INSURE method. Infants in the success group had less severe RDS and less occurrence of sepsis and pneumothorax, lower mortality, and shorter duration of stay in the NICU than infants in the failure group. A birth weight <750 g, pO(2)/FiO(2) <218, and a/ApO(2) <0.44 at the first blood gas analysis were independent risk factor for INSURE failure.
The INSURE method can be applied to the majority of extremely preterm infants and is followed by a high percentage of success.
我们的目的是确定能够区分可采用INSURE（气管插管-肺表面活性物质-拔管）方法预防机械通气（MV）的婴儿的临床特征，以及能够预测INSURE方法成功或失败的特征。
孕周<30周的足月儿被分为三组：（1）产房内需要机械通气的婴儿；（2）仅接受鼻塞持续气道正压通气（NCPAP）治疗的自主呼吸婴儿；（3）接受INSURE方法治疗的婴儿。
我们研究了125例婴儿：30例（24%）需要机械通气，75例（60%）接受INSURE治疗，20例（16%）接受NCPAP治疗。68例（91%）婴儿通过INSURE方法成功治疗。成功组婴儿的呼吸窘迫综合征（RDS）较轻，败血症和气胸发生率较低，死亡率较低，在新生儿重症监护病房（NICU）的住院时间比失败组婴儿短。出生体重<750g、首次血气分析时的动脉血氧分压/吸入氧浓度（pO₂/FiO₂）<218以及肺泡-动脉血氧分压差/动脉血氧分压（a/ApO₂）<0.44是INSURE失败的独立危险因素。
INSURE方法可应用于大多数极早产儿，成功率较高。
