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目的探讨肺表面活性物质(PS)联合布地奈德对伴呼吸窘迫综合征(RDS)的极低出生体质量儿(VLBWI)心功能的保护作用,并评估联合用药的效果。方法选取2010年8月-2011年3月南京市妇幼保健院收治的胎龄<34周、出生体质量<1 500 g、出生4 h内发生RDS的早产儿30例,将其随机分为PS+布地奈德组和PS组。PS+布地奈德组使用PS和布地奈德混合剂(每70 mg PS中加入0.25 mg布地奈德),PS剂量70 mg.kg-1,布地奈德0.25 mg.kg-1。PS组单使用PS,剂量70 mg.kg-1。在出生30～60 min由气管内滴入。于1、7、14 d进行血清CK-MB和肌钙蛋白测定,同时进行超声心动图检查,对左心室射血分数(LVEF)、右心室射血分数(RVEF)、二尖瓣舒张早期和舒张晚期血流峰比值(MVE/A)、三尖瓣舒张早期和舒张晚期血流峰比值(TVE/A)、左心室(LV)-Tei指数进行测定。结果 PS+布地奈德组血清CK-MB和肌钙蛋白14 d低于PS组(Pa<0.05);与PS组比较,PS+布地奈德组心脏收缩功能LVEF 14 d明显增加(P<0.05),RVEF 7、14 d均明显增加(Pa<0.05)。2组MVE/A和TVE/A均逐渐增加,PS+布地奈德组增加明显,MVE/A 14 d,TVE/A 7、14 d与PS组比较差异有统计学意义(Pa<0.05)。PS+布地奈德组LV-Tei指数14 d低于PS组(P<0.05)。结论使用PS联合布地奈德对伴RDS的VLBWI进行干预对其心脏具有保护作用,可促进心脏功能恢复。
Objective To investigate the protective effects of pulmonary surfactant (PS) combined with budesonide on heart function of very low birth weight (VLBWI) patients with respiratory distress syndrome (RDS) and evaluate the effect of combination therapy. Methods From March 2010 to March 2011, 30 preterm infants with gestational age <34 weeks, birth weight <1 500 g, and RDS within 4 hours of birth were selected from Nanjing MCH center and randomly divided into PS + Budesonide group and PS group. The PS + budesonide group received PS and budesonide (0.25 mg budesonide per 70 mg PS), PS dose 70 mg.kg-1 and budesonide 0.25 mg.kg-1. PS group PS alone, the dose of 70 mg.kg-1. In 30 to 60 min at birth by tracheal instillation. Serum levels of CK-MB and troponin were measured at 1, 7, 14 days, and echocardiography was performed at the same time. The left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), early mitral diastolic and The peak value of diastolic blood flow (MVE / A), tricuspid early diastolic and diastolic blood flow peak ratio (TVE / A) and left ventricular (LV) -Tei index were measured. Results The serum CK-MB and troponin in PS + budesonide group were lower than those in PS group on 14 d (P <0.05). Compared with PS group, the cardiac contractile function LVEF in PS + budesonide group increased significantly on the 14th day (P <0.05) RVEF 7,14 d were significantly increased (Pa <0.05). Both MVE / A and TVE / A increased gradually in PS + budesonide group, and the difference was statistically significant (P <0.05) between MVE / A 14 d and TVE / A 7 and 14 d groups. The LV-Tei index in PS + budesonide group was lower than that in PS group 14 d (P <0.05). Conclusions The intervention of PS combined with budesonide on VLBWI with RDS has a protective effect on the heart and can promote the recovery of cardiac function.