陈创鑫　郑庆藩　余智荣

[摘要] 目的 觀察应用布地奈德制剂配合肺表面活性物质（PS）治疗新生儿呼吸窘迫综合征 （NRDS）的临床疗效。方法 选取 2015 年 11 月～2016 年 11 月在本院住院且符合诊断标准新生儿呼吸窘迫综合征（NRDS）早产极低体重儿（VLBWI）100例，随机分成治疗组和对照组，每组 50例。对照组给予综合治疗配合肺表面活性物质（PS），治疗组在此基础上给予布地奈德制剂联合治疗。 结果 治疗组4例改用机械通气，占 8.16%；对照组15 例改用机械通气，占30.61%，两组比较差异有统计学意义（P<0.05）；治疗组 5 例需重复使用肺表面活性物质（PS），占10.2%；对照组16例，占32.65%，差异有统计学意义（P<0.05）；治疗组吸气性三凹征较对照组明显改善，吸氧时间较对照组缩短，差异有统计学意义（P<0.05）。 结论 布地奈德制剂联合肺表面活性物质（PS）配合鼻塞持续气道正压通气（CPAP）治疗新生儿呼吸窘迫综合征（NRDS）能减少肺表面活性物质（PS）的使用，减少机械通气，改善呼吸困难，缩短吸氧时间，有利于早产极低体重儿尽早停氧，防止出现肺部损伤，值得临床推广应用。

[关键词] 早产极低体重儿；新生儿呼吸窘迫综合征；布地奈德；鼻塞持续气道正压通气

[中图分类号] R722.1 [文献标识码] B [文章编号] 1673-9701（2017）16-0048-06

[Abstract] Objective To observe the clinical efficacy of budesonide preparations combined with pulmonary surfactant （PS） in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods A total of 100 preterm low birth weight infants （VLBWI） in our hospital who met the diagnostic criteria of neonatal respiratory distress syndrome （NRDS） from November 2015 to November 2016 were chosen and randomly divided into the treatment group（n=50） and the control group（n=50）. The control group was treated with the comprehensive treatment combined with pulmonary surfactant（PS）， and the treatment group was given budesonide preparations on the basis of the treatment of the control group. Results 4 patients in the treatment group switched to mechanical ventilation， accounting for 8.16%.15 patients of the control group switched to mechanical ventilation， accounting for 30.61%， and the difference between the two groups was statistically significant（P<0.05）. In the treatment group， 5 cases were treated repeatedly with pulmonary surfactant（PS）， accounting for 10.2%. In the control group， 16 cases were treated repeatedly with pulmonary surfactant（PS）， accounting for 32.65%. There was statistically significant difference between the two groups（P<0.05）. The inspiratory three concave sign of the treatment group was significantly improved， and the oxygen time in the treatment group was shorter than that in the control group， and the difference was statistically significant（P<0.05）. Conclusion The combination of budesonide preparations， pulmonary surfactant（PS） and nasal congestion positive airway pressure（CPAP） in the treatment of neonatal respiratory distress syndrome（NRDS）， can reduce the use of pulmonary surfactant（PS）， reduce mechanical ventilation， improve breathing difficulties， and shorten the oxygen time. The combined treatment is conducive to early termination of oxygen for very low birth weight preterm children，which prevents the emergence of lung injury， and is worthy of clinical application of newborns.

[Key words] Very low birth weight preterm children；Neonatal respiratory distress syndrome；Budesonide；Nasal congestion positive airway pressure

新生儿呼吸窘迫综合征[1]（neonatal respiratory distress syndrome，NRDS）是早产极低体重儿[2]（very low birth weight infant，VLBWI）出生后肺部发育不成熟及肺部严重感染的早期表现；肺表面活性物质的替代治疗[3]和机械通气[4]的呼吸支持是当前新生儿医学界公认的治疗措施。当前大量文献报道以肺表面活性物质[5]（pulmonary surfactant，PS）为载体的布地奈德[6]（budesonide，BUD）混合制剂对预防和治疗新生儿呼吸窘迫综合征、改善预后效果显著，优于单用肺表面活性物质（PS），并能明显减少肺表面活性物质（PS）的重复使用；而且肺表面活性物质（PS）市场价格昂贵，广泛推广及重复使用存在困难。为明确了解气管内滴入肺表面活性物质和布地奈德的混合制剂的早期临床疗效及特点，对本院100例出生后出现新生儿呼吸窘迫综合征（NRDS）的高危早产极低体重儿（VLBWI）进行了临床对比研究，现报道如下。

1 资料与方法

1.1一般资料

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