Objective: To explore the clinical efficacy of intratracheal instillation of pulmonary surfactant (PS) combined with budesonide for preventing bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants.
Methods: Thirty VLBW infants with gestational age <32 weeks who developed neonatal respiratory distress syndrome (NRDS) (grade III-IV) suffering from intrauterine infection were randomly assigned into a PS + budesonide group and a PS alone group. The changes were compared between the two groups in arterial blood gas indexes, oxygenation index (OI), duration of mechanical ventilation, duration of oxygen supplementation, incidence of BPD, mortality rate at 36 weeks corrected gestational age and incidences of other complications except BPD.
Results: Compared with the PS alone group, the PS+budesonide group had a lower incidence of BPD, shorter duration of mechanical ventilation and oxygen supplementation (P<0.05). On the 2nd to 6th day after treatment, the PS+budesonide group had higher pH value of arterial blood gas and OI and lower carbon dioxide partial pressure compared with the PS alone group (P<0.05). There were no significant differences in the mortality rate at 36 weeks corrected gestational age and the incidences of other complications except BPD between the two groups (P>0.05).
Conclusions: Intratracheal instillation of PS combined with budesonide can effectively reduce the incidence of BPD in VLBW premature infants with severe NRDS.
目的: 探讨肺表面活性物质（PS）联合布地奈德气管内滴入预防极低出生体重早产儿支气管肺发育不良（BPD）的临床疗效。
方法: 选取胎龄 < 32周的患有宫内感染的呼吸窘迫综合征（NRDS）（Ⅲ或Ⅳ级）的极低出生体重儿30例，随机分成PS+布地奈德组（15例）和PS组（15例）。比较两组血气分析、氧合指数（OI）、呼吸机使用时间、吸氧时间、BPD发生率、纠正胎龄36周时病死率以及其他并发症的发生率。
结果: PS+布地奈德组患儿BPD发生率低于PS组，呼吸机使用时间和吸氧时间明显短于PS组（P < 0.05）；给药后第2~6天，PS+布地奈德组pH、OI均高于PS组，PaCO2均低于PS组，且差异均有统计学意义（P < 0.05）；两组间纠正胎龄36周时病死率以及其他并发症差异无统计学意义。
结论: PS联合布地奈德气管内滴入能有效降低重度NRDS极低出生体重早产儿BPD的发生率。