固尔苏与珂立苏治疗早产儿呼吸窘迫综合征疗效的比较研究
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江苏省卫生厅科技基金资助(H200642)


A comparison of curosurf and calsurf on preterm infants respiratory distress syndrome
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    摘要:

    目的: 评价猪肺表面活性物质(固尔苏)与牛肺表面活性物质(珂立苏)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的疗效和安全性-方法:对南京医科大学附属南京儿童医院新生儿重症监护室2007年1月~2009年7月收治的81例使用肺表面活性物质且进行机械通气的RDS患儿进行分析-81例RDS患儿分入两个组:固尔苏组(54例)和珂立苏组(27例)-分别气管插管给药,比较两组用药前后血气指标-机械通气参数-氧合指数-机械通气时间-用氧时间-住院时间和并发症-结果:用药24 h后两组患儿氧合及机械通气参数较用药前明显改善,差异有显著性意义(P均<0.05)-两组用药后的血气指数-机械通气时间-用氧时间-住院时间及并发症,包括动脉导管未闭(patent ductus arteriosus,PDA)-视网膜病变(retinopathy of prematurity,ROP)-坏死性小肠结肠炎(necrotizing enterocolitis,NEC)-气胸-肺出血和死亡发生率均无统计学差异-两组在治疗后都有持续的平均气道压(mean airway pressure,MAP)和氧合指数(oxygenation index,OI)改善,但起效速度有差别-固尔苏组在用药后的4 h内MAP和OI明显降低(P < 0.01),珂立苏在4~8 h内临床起效速度最快(P < 0.05)-结论:固尔苏与珂立苏在给药后的疗效及安全性相当-固尔苏起效速度较珂立苏快,应根据不同的起效速度及时合理调整呼吸机参数,减少并发症的发生-

    Abstract:

    Objective: To evaluate the efficacy and safety of two natural surfactants (curosurf and calsurf) on the treatment of preterm infants respiratory distress syndrome(RDS). Methods:From January 2007 to July 2009, we conducted a trial at the neonatal intensive care unit of Nanjing Children’s Hospital. Eighty-one premature babies suffered from RDS and requiring mechanical ventilation(MV)were recruited and divided into two groups:54 in curosurf group and 27 in calsurf group. The surfactant was administered by endotracheal intubation. Blood gas index,ventilator parameters,oxygenation index(OI),the duration of ventilator dependence and hours of oxygen requirement,time in hospital and incidence of complications before and after surfactant administration were analyzed and compared. Results:The oxygenization and ventilator parameters of the two groups showed significant improvements at 24h after administration in comparison with those before surfactant therapy(both P<0.05). There were no statistical differences in the duration of MV or oxygenation,hospitalization time. No statistically significant differences were found in incidence of mortality or complications,which included retinopathy(ROP)and necrotizing enterocolitis(NEC),pneumonorrhagia,pneumatothorax,patent ductus arteriosus (PDA). Both groups had sustained decreasing mean airway pressure(MAP)and OI after surfactant therapy,but time-effect curves were different. MAP and OI of curosurf group decreased most significantly within the initial 4 hours after administration (P < 0.01)compared to the calsurf group,which mainly decreased between the 4th hour and the 8th hour after administration(P < 0.05). Conclusion:In the treatment of preterm infants with RDS,the efficacy and safety of curosurf and calsurf were similar,while curosurf works earlier than calsurf. We should adjust the MV parameters properly in accordance with the different time-effect curves of the two surfactants,so as to reduce complications.

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包志丹,程 锐,邹芸苏,阚 清,缪晓林,周晓玉.固尔苏与珂立苏治疗早产儿呼吸窘迫综合征疗效的比较研究[J].南京医科大学学报(自然科学版),2010,(12):1748-1751

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