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目的探讨肺表面活性物质珂立苏治疗早产儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)对脑血流动力学的影响。方法 2008年5月至2010年3月,共收治NRDS早产儿301例,观察组(使用珂立苏)162例,对照组(未使用珂立苏)139例。观察组在使用珂立苏前,及使用后0.5、6、12、24、48h采用头颅B超测定脑血流动力学参数,对照组在开始呼吸机辅助呼吸时及0.5、6、12、24、48h进行相同检查。测定的脑血流参数包括:双侧大脑前、中、后动脉及基底动脉收缩期峰值流速(Vs)、舒张末期流速(Vd)及血流阻力指数(RI)。检测完成后按照胎龄相差不超过1周,出生体质量相差不超过500g;初次摄胸片提示的NRDS分级级数相同原则进行逐一配对分析。结果未能完成相关检测指标的观察组33例、对照组41例排除在本研究之外,剩余的观察组129例,对照组98例逐一配对,最终纳入配对数为71对。与对照组相比,观察组除在使用珂立苏后30min时间点大脑前动脉收缩期峰值流速、中动脉血流阻力指数、12h时间点中动脉血流阻力指数低于对照组(P<0.05)外,其余各时间点2组间脑血流参数指标差异无显著性意义(P>0.05)。结论气管内缓慢注入珂立苏治疗早产儿NRDS对脑血流动力学变化无显著影响。
Objective To investigate the effect of pulmonary surfactant Keli Su on cerebral hemodynamics in neonatal respiratory distress syndrome (NRDS). Methods From May 2008 to March 2010, 301 preterm infants with NRDS, 162 infants in the observation group (with coriolis) and 139 in the control group (without using clofazoo) were enrolled. In the observation group before the use of clofusulfide, and after 0.5,6,12,24,48h use of brain B-measure hemodynamic parameters, the control group at the beginning of ventilator-assisted breathing and 0.5,6,12,24 , 48h for the same examination. The measured parameters of cerebral blood flow include peak systolic velocity (Vs), end-diastolic velocity (Vd) and blood flow resistance index (RI) of bilateral anterior, middle and posterior cerebral arteries and basilar artery. After the test is completed according to gestational age difference of not more than 1 week, birth weight difference does not exceed 500g; initial chest X-ray prompts NRDS classification progression of the same principle one by one paired analysis. Results The observation group failed to complete the relevant test 33 cases, the control group of 41 cases excluded from the study, the remaining observation group of 129 cases, the control group of 98 cases one by one pairing, the final inclusion of pairs of pairs of 71 pairs. Compared with the control group, the peak flow velocity of systolic cerebral artery, the middle-artery blood flow resistance index and the index of arterial blood flow resistance in the observation group were lower than those in the control group (P <0.05 ), There was no significant difference of cerebral blood flow parameters between the other two time points (P> 0.05). Conclusion Intratracheal instillation of clofosulfate in premature infants treated with NRDS had no significant effect on cerebral hemodynamics.