较少侵入性表面活性剂的管理 (LISA) 与输管表面活性剂的输出 (InSurE) 技术相比,在治疗呼吸困扰综合征的新生儿时使用较高容量的表面活性剂:一个开放的随机对照试验
Saamic Hooda1, Jagjit Singh Dalal2, Kapil Bhalla1
1Department of Pediatrics, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
European journal of pediatrics
|May 29, 2025
概括
较少侵入性表面活性剂 (LISA) 和输管表面活性剂输管 (InSurE) 在治疗早产婴儿的呼吸应急综合征 (RDS) 中同样有效. 使用具有成本效益的牛表面活性剂与非侵入性通风显示了两种方法的可比结果.
科学领域:
- 新生儿医学 新生儿医学
- 呼吸系统生理学 呼吸系统生理学
- 儿科重症监护 儿科重症监护
背景情况:
- 呼吸应急综合征 (RDS) 是早产新生儿的常见疾病.
- 目前的表面活性剂管理技术包括输管表面活性剂输管 (InSurE) 和少侵入性表面活性剂管理 (LISA).
- 现有的研究通常使用昂贵的,低容量表面活性剂与LISA,通常与nCPAP支持.
研究的目的:
- 为了比较InSurE与LISA在RDS的早产新生儿中表面活性剂的有效性.
- 评估在低收入和中等收入国家使用一种更经济,更大容量的牛表面活性剂与非侵入性正压通风 (NIPPV).
- 评估在生命的前72小时内需要侵入性机械通风 (IMV) 的需要.
主要方法:
- 一项随机对照试验,涉及100名早产婴儿 (怀孕26-34周) 患有RDS.
- 婴儿通过InSurE或LISA接受牛脂提取物表面活性剂 (100毫克/公斤).
- 非侵入性正压通风 (NIPPV) 是呼吸支持的主要方式.
主要成果:
- 在LISA (28%) 和InSurE (30%) 组之间在72小时内需要IMV没有显著差异 (p=0.86).
- 血液动力学上显著的专利动脉管 (hsPDA),严重的腹腔内出血 (IVH) 和支气管肺功能失调 (BPD) 的比较率在两组之间.
- 没有观察到肺出血,心/脱发作或BPD/死亡的综合结果的显著差异.
结论:
- 在使用NIPPV时,LISA和InSurE都是可行的,同样有效的新生儿RDS表面活性剂的施用策略.
- 使用更大容量,更具成本效益的牛表面活性剂并没有给LISA与Insure相比带来额外的优势.
- 具有经济性,更高容量的表面活性剂的LISA是NIPPV与NIPPV一起在资源有限的环境中提供呼吸支持的可行选择.
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