Yang Guang, Hei Mingyan, Xue Zhimin, Zhao Yuan, Zhang Xinhua, Wang Chenghu
Neonatal Center, Beijing Children's Hospital, Capital Medical University, Beijing.
Department of Pediatrics, Shanxi Medical University.
Medicine (Baltimore). 2020 Feb;99(9):e19216. doi: 10.1097/MD.0000000000019216.
To explore the clinical effects of less invasive surfactant administration (LISA) via a gastric tube on the treatment of respiratory distress syndrome (RDS) in premature infants aged 32 to 36 weeks.A total of 97 premature infants with RDS admitted to the Children's Hospital of Shanxi from February 2017 to January 2018 were randomly divided into LISA (47 cases) and (intubation-surfactant-extubation,) INSURE groups (50 cases). In the LISA group, 6F gastric tubes were inserted into the trachea through direct laryngoscopy under nasal continuous positive airway pressure (NCPAP), and pulmonary surfactant (PS) was injected. In the INSURE group, PS was injected via tracheal intubation and NCPAP was performed after extubation. The incidence of technical-related adverse events and various complications in the two groups were observed.PS was successfully injected through gastric tube in the LISA group. There were no significant differences in reflux, asphyxia, bradycardia (<100 beats/min), apnea, FiO2, changes in PaO2 and PaCO2 at 1 hour post-treatment between the groups. During the course of administration, blood pressure and SpO2 in the LISA group were more stable, and significant differences between the 2 groups were observed. However, no significant differences in the complications and outcomes between the 2 groups occurred.The LISA technique can be used to treat premature infants with RDS aged 32 to 36 weeks with stronger spontaneous breathing ability. Further clinical studies are required to determine the optimal strategy of LISA administration and the most profitable patient population.
探讨经胃管微创注入表面活性物质(LISA)对32至36周龄早产儿呼吸窘迫综合征(RDS)的治疗效果。选取2017年2月至2018年1月在山西省儿童医院收治的97例RDS早产儿,随机分为LISA组(47例)和INSURE组(插管-表面活性物质-拔管,50例)。LISA组在鼻塞持续气道正压通气(NCPAP)下经直接喉镜将6F胃管插入气管,注入肺表面活性物质(PS)。INSURE组经气管插管注入PS,拔管后行NCPAP。观察两组技术相关不良事件及各种并发症的发生率。LISA组经胃管成功注入PS。两组间治疗后1小时反流、窒息、心动过缓(<100次/分钟)、呼吸暂停、FiO2、PaO2和PaCO2变化差异无统计学意义。给药过程中,LISA组血压和SpO2更稳定,两组间差异有统计学意义。然而,两组并发症及预后差异无统计学意义。LISA技术可用于治疗呼吸自主能力较强的32至36周龄RDS早产儿。需要进一步的临床研究来确定LISA给药的最佳策略和最受益的患者群体。