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目的探讨乌司他丁辅助防治早产儿支气管肺发育不良(BPD)的临床价值。方法胎龄32周以下、体重1 500 g以下、需有创机械通气的新生儿呼吸窘迫综合征(NRDS)患儿112例,随机分为两组,每组56例。对照组予外源性肺表面活性物质(PS)替代治疗加气管插管肺保护性机械通气治疗,以及限制液体、控制感染、营养支持治疗,后逐步调整、撤离呼吸机,改用持续正压通气(CPAP)呼吸支持,病情稳定后逐步停氧。乌司他丁组在对照组治疗方案的基础上加用乌司他丁10 000 U·kg~(-1)·d~(-1),疗程3周。比较两组BPD发生率,机械通气、CPAP辅助通气、总用氧时间,并观察不良反应发生情况。结果乌司他丁组完成治疗50例,对照组完成47例。乌司他丁组BPD发生率4%(2/50),低于对照组[21%(10/47),P<0.05]。乌司他丁组机械通气、CPAP辅助通气、总用氧时间分别为(103.7±18.7)、(153.2±16.3)、(478.5±38.1)h,均低于对照组[(147.6±19.3)、(201.8±74.7)、(597.4±97.5)h,P<0.05]。未见明显不良反应发生。结论乌司他丁可以减少NRDS患儿的机械通气、CPAP辅助通气和总用氧时间,可能对防治BPD有效。
Objective To investigate the clinical value of ulinastatin in preventing and treating bronchopulmonary dysplasia (BPD) in preterm infants. Methods One hundred and twelve children with neonatal respiratory distress syndrome (NRDS) requiring mechanical ventilation were randomly divided into two groups (56 in each group). The control group was given exogenous pulmonary surfactant (PS) replacement therapy plus intubation lung protective mechanical ventilation therapy, as well as to limit the liquid, infection control, nutrition support treatment, and then gradually adjust, evacuate the ventilator, switch to continuous positive pressure Ventilation (CPAP) respiratory support, the disease was stable and gradually stop oxygen. The ulinastatin group was treated with ulinastatin 10 000 U · kg -1 d -1 for 3 weeks on the basis of the control group. The incidence of BPD, mechanical ventilation, CPAP-assisted ventilation and total oxygen administration time were compared between the two groups, and the incidence of adverse reactions was observed. Results The ulinastatin group completed the treatment of 50 cases, the control group completed 47 cases. The incidence of BPD was 4% (2/50) in the ulinastatin group, which was lower than that in the control group [21% (10/47), P <0.05]. In the ulinastatin group, mechanical ventilation and CPAP assisted ventilation were (103.7 ± 18.7), (153.2 ± 16.3) and (478.5 ± 38.1) h, both lower than those in the control group [(147.6 ± 19.3), 201.8 ± 74.7), (597.4 ± 97.5) h, P <0.05]. No obvious adverse reactions occurred. Conclusion Ulinastatin can reduce mechanical ventilation, CPAP-assisted ventilation and total oxygenation time in children with NRDS, which may be effective in preventing and treating BPD.