沐舒坦不同给药方式预防早产儿呼吸窘迫综合征疗效观察

Efficacy of intravenous or atomizing ambroxol for prevention of respiratory distress syndrome in preterm infants

摘要:

目的：沐舒坦具有促进肺表面活性物质合成和分泌的作用。近年来已有较多学者将其用于预防早产儿呼吸窘迫综合征(RDS),取得了较好的临床疗效。该研究旨在比较静脉和雾化两种不同途径使用沐舒坦预防早产儿RDS的疗效。方法：将我院产科出生的早产儿(胎龄28～37周)随机分为静脉给药组、雾化吸入组两个用药组及未用沐舒坦的对照组,静脉给药组于出生后立即从脐静脉注射沐舒坦15mg/kg,随后静脉点滴每日30mg/kg,分2次给药;雾化给药组给予氧气驱动雾化吸入沐舒坦每日30mg/kg,分2次给药,均用药2d;对照组不使用沐舒坦。比较3组RDS的发生率、并发症及住院6h血气分析结果。结果：①静脉给药组RDS的发生率为7.5%,雾化给药组为5.0%,对照组为24.4%,两用药组间比较差异无显著性,但均低于对照组(P<0.05)。②两用药组住院6h的血气分析结果与对照组比较差异有显著性(P<0.05),两用药组间比较差异无显著性。③两用药组并发症发生率明显低于对照组(P<0.05),两用药组间比较差异无显著性。结论：新生儿早期使用沐舒坦预防RDS,具有一定疗效,无论是经静脉还是雾化给药,均能获得相同的效果。

Abstract:

OBJECTIVE: Ambroxol induces the synthesis of surfactant in lung alveolar type II cells. Some studies have shown its effectiveness for the prevention of respiratory distress syndrome (RDS) in preterm infants. This study aimed to compare the efficacy of two different ways of ambroxol administration, ie, intravenous injection and atomizing inhalation, for the prevention of RDS in preterm infants. METHODS: A total of 125 preterm infants born between 28-37 weeks of gestation were randomly assigned into three groups: Intravenous and Atomizing ambroxol treatment groups (n=40 each) or Control group (n=45). The Intravenous group was injected with 15 mg/kg of ambroxol through the umbilical vein immediately after birth and then received 30 mg/kg of ambroxol daily for 2 days by intravenous drip. The Atomizing group was administered with 30 mg/kg of ambroxol daily for 2 days by atomizing inhalation immediately after birth. The Control group received no ambroxol treatment. The incidences of RDS and complications as well as the blood gas results 6 hrs after birth were compared among the three groups. RESULTS: The incidence of RDS was 7.5%, 5.0% and 24.4% in the Intravenous, Atomizing and Control groups respectively. There were no significant differences in the incidence of RDS between the two ambroxol treatment groups. However, the incidence of RDS in the two treatment groups were noticeably lower than in the Control group (P<0.05). The blood gas results did not show significant differences between the two ambroxol treatment groups but both groups demonstrated improved blood gas results compared with the Control group at 6 hrs after birth (P<0.05). The incidence of complications, such as pulmonary hemorrhage, respiratory failure, intraranial hemorrhage, in the two ambroxol treatment groups was reduced compared with the Control group (P<0.05), but there were no differences between the two ambroxol groups. CONCLUSIONS: Early administration of either intravenous or atomizing ambroxol can produce a positive efficacy for the prevention of RDS in preterm infants. The two different ways of administration seem to result in a similar efficacy in the prevention of RDS.