肺出血后表面活性物质补充对胎龄<34周早产儿临床预后的改善效用

doi:10.12372/jcp.2025.25e0126

Abstract

Abstract:

Objective Whether exogenous pulmonary surfactant (PS) administration could prolong the survival time of preterm infants after pulmonary hemorrhage is currently a lack of sufficient evidence. This study was conducted to evaluate the effect of surfactant administration after pulmonary hemorrhage on the survival prognosis of preterm infants. Methods The study participants were preterm babies, gestational age (GA) <34 weeks, with pulmonary hemorrhage admitted from January 1, 2017 to December 31, 2022. After pulmonary hemorrhage, infants would be given an additional dose of PS if the parents agreed. The timing of administration is usually 2-4 hours after the pulmonary hemorrhage stabilizes. Accordingly, the participants were retrospectively divided into the PS administration group after pulmonary hemorrhage (n=16) and the non-PS administration group after pulmonary hemorrhage (n=40) according to the records from hospital information system. Results It was found that the blood gas was better after PS administration. Moreover, the survival time, duration of caffeine administration, and duration of invasive ventilation were significantly longer in the PS administration group (P<0.05). The intergroup comparison showed that the application of PS after pulmonary hemorrhage could reduce the short-term all-cause mortality within 72 hours and 168 hours (P<0.05), but for the all-cause mortality within 702 hours and during the complete hospitalization period, there was no significant difference between the two groups. The Log-rank test of the survival curve showed that the application of PS after pulmonary hemorrhage could reduce the risk of death within 72 hours, within 168 hours, and during the full hospitalization period (P<0.05), except for the risk of death within 702 hours. The Breslow test showed that the application of PS after pulmonary hemorrhage could significantly prolong the survival time from 72 hours after pulmonary hemorrhage to discharge (P<0.05). Conclusion Administering PS to preterm infants with gestational age <34 weeks after pulmonary hemorrhage may have potential benefits, further clinical studies are needed to explore whether this treatment can improve the long-term outcomes.

Key words: pulmonary hemorrhage, prognosis, mortality, pulmonary surfactant, mechanical ventilation

CLC Number:

LIU Yun, PAN Jingjing, SHEN Jinxin, ZOU Yunsu, CHENG Rui, FENG Yun, YANG Yang. Therapeutic efficacy of surfactant supplementation after pulmonary hemorrhage in improving clinical outcomes of preterm infants with gestational age <34 weeks[J].Journal of Clinical Pediatrics, 2025, 43(9): 652-660.

Figures/Tables 6

Figure 1

Table 1

Table 2

Comparison of main diagnoses, therapies, ventilator parameters, and laboratory tests between PS administration after pulmonary hemorrhage group and non-PS administration after pulmonary hemorrhage group"

因素	PS应用组(n=16)	PS未应用组(n=40)	统计量	P
主要诊断
Ⅲ-Ⅳ级RDS[n(%)]	8(50.00)	28(70.00)	χ²=1.99	0.158
药物及手术治疗PDA[n(%)]	9(56.25)	26(65.00)	χ²=0.37	0.541
早发型败血症[n(%)]	3(18.75)	5(12.50)	χ²=0.03	0.856
呼吸系统主要治疗
肺出血前给予PS[n(%)]	14(87.50)	37(92.50)	-	0.617^1）
肺出血前给予2剂及以上PS[n(%)]	3(18.75)	12(30.00)	χ²=0.28	0.600
咖啡因用药时长[M(P₂₅~P₇₅)]/d	27.50(10.50~44.50)	5.50(2.00~38.50)	Z=2.02	0.044
肺出血后高频通气[n(%)]	7(43.75)	16(40.00)	χ²=0.07	0.797
有创通气时长[M(P₂₅~P₇₅)]/d	174.00(75.50~497.25)	88.00(39.75~255.75)	Z=2.10	0.036
无创通气时长[M(P₂₅~P₇₅)]/d	109.00(0.00~261.50)	0.00(0.00~322.00)	Z=0.90	0.371
有创通气次数(≥2次)[n(%)]	5(31.25)	13(32.50)	χ²=0.01	0.928
NO吸入[n(%)]	2(12.50)	6(15.00)	χ²=0.00	1.000
机械通气
肺出血前FiO₂[M(P₂₅~P₇₅)]/%	30.00(30.00~40.00)	30.00(27.50~40.00)	Z=0.65	0.519
肺出血后FiO₂[M(P₂₅~P₇₅)]/%	90.00(46.25~100.00)	100.00(55.00~100.00)	Z=0.84	0.403
血气分析[M(P₂₅~P₇₅)]
肺出血1小时内pH值	7.06(6.87~7.13)	7.02(6.85~7.15)	Z=0.13	0.900
肺出血1小时内BE/mmol·L^-1	-12.95(-17.98~-11.50)	-12.75(-18.18~-8.83)	Z=0.63	0.527
肺出血1小时内PaCO₂/mmHg	58.50(47.00~81.80)	70.00(53.40~82.80)	Z=0.59	0.559
肺出血1小时内PaO₂/mmHg	41.00(30.00~76.00)	51.00(27.00~86.25)	Z=0.41	0.684
肺出血6小时后pH值	7.23(7.13~7.35)	7.13(7.00~7.27)	Z=2.04	0.041
肺出血6小时后BE/mmol·L^-1	-4.45(-10.30~-1.58)	-10.10(-11.93~-6.48)	Z=2.11	0.035
肺出血6小时后PaCO₂/mmHg	53.40(37.00~60.10)	61.65(51.45~81.43)	Z=2.15	0.031
肺出血6小时后PaO₂/mmHg	74.00(45.00~95.00)	45.00(35.25~72.50)	Z=2.08	0.038
肺出血24小时后pH值	7.31(7.24~7.42)	7.21(7.12~7.34)	Z=2.19	0.028
肺出血24小时后BE/mmol·L^-1	-3.40(-5.70~-2.00)	-6.40(-8.88~-1.48)	Z=0.98	0.329
肺出血24小时后PaCO₂/mmHg	45.30(31.90~57.40)	58.30(43.05~62.13)	Z=1.93	0.054
肺出血24小时后PaO₂/mmHg	85.00(73.00~95.00)	60.00(50.00~79.50)	Z=2.42	0.016
凝血功能[M(P₂₅~P₇₅)]
肺出血后血小板×10⁹·L^-1	115.50(80.75~155.25)	135.00(63.50~181.75)	Z=0.62	0.537
肺出血后PT/s	17.80(15.70~22.20)	20.65(18.15~25.18)	Z=1.58	0.114
肺出血后APTT/s	90.20(57.60~125.10)	68.20(59.85~99.30)	Z=0.31	0.760
肺出血后TT/s	21.80(18.25~25.65)	22.20(18.53~25.60)	Z=0.02	0.988
肺出血后INR	1.59(1.41~1.99)	1.84(1.61~2.27)	Z=1.52	0.128

Table 2

Table 3

Table 4

Figure 2

References 27

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因素	PS应用组（n=16）	PS未应用组（n=40）	统计量	P
母亲数据[n(%)]
足疗程产前激素	8(50.00)	10(25.00)	χ²=3.28	0.070
羊水污染	0(0.00)	2(5.00)	-	1.000^1）
剖宫产	10(62.50)	19(47.50)	χ²=1.03	0.310
母亲糖尿病^2）	4(25.00)	9(22.50)	χ²=0.00	1.000
母亲高血压^3）	2(12.50)	11(27.50)	χ²=0.72	0.395
胎膜早破>18小时	3(18.75)	11(27.50)	χ²=0.12	0.733
新生儿数据
生后6小时内气管插管[n(%)]	13(81.25)	37(92.50)	-	0.338^1）
1分钟Apgar [M（P₂₅~P₇₅）]	8.00(6.00~8.00)	7.00(5.00~8.00)	Z=0.81	0.417
5分钟Apgar [M（P₂₅~P₇₅）]	8.00(7.00~9.00)	8.00(8.00~9.00)	Z=0.38	0.706
出生体重（ x±s)/g	1 176.25±224.85	1 049.25±239.89	t=1.82	0.074
男性[n(%)]	10(62.50)	24(60.00)	χ²=0.03	0.863
胎龄( x±s)/周	28.92±2.01	28.05±1.59	t=1.72	0.092
小于胎龄儿[n(%)]	1(6.25)	4(10.00)	-	1.000^1）
出生时体温( x±s)/℃	35.81±0.63	35.58±0.80	t=0.99	0.328
血气分析[M（P₂₅~P₇₅）]
出生时pH值	7.23(7.14~7.38)	7.29(7.23~7.35)	Z=0.56	0.577
出生时BE值/mmol·L^-1	-5.90(-10.25~-2.50)	-6.00(-8.80~-3.80)	Z=0.31	0.754
出生时PaCO₂/mmHg	46.90(38.95~70.10)	45.10(33.90~57.45)	Z=0.80	0.422
出生时PaO₂/mmHg	94.00(50.75~101.25)	78.00(55.25~100.25)	Z=0.52	0.605
肺出血发生日龄[M（P₂₅~P₇₅）]/d	2.50(2.00~6.75)	3.00(2.00~6.00)	Z=0.60	0.547

因素	PS应用组(n=16)	PS未应用组(n=40)	统计量	P
BPD[n(%)]	7(43.75)	12(30.00)	χ²=0.96	0.326
中-重度BPD[n(%)]	2(12.50)	4(10.00)	-	1.000^1）
气胸[n(%)]	1(6.25)	2(5.00)	-	1.000^1）
NEC(≥Ⅱ期)[n(%)]	1(6.25)	7(17.50)	χ²=0.44	0.507
ROP[n(%)]	3(18.75)	4(10.00)	χ²=0.20	0.655
IVH(≥Ⅲ级)[n(%)]	5(31.25)	11(27.50)	χ²=0.00	1.000
住院时长[M(P₂₅~P₇₅)]/d	39.50(6.75~59.25)	4.50(2.00~54.50)	Z=1.87	0.061

因素	PS应用组	PS未应用组	统计量	P	把握度
院内死亡[n(%)]	7(43.75)	27(67.50)	χ²=2.70	0.100	0.377
肺出血后72小时内全因死亡[n(%)]	3(18.75)	22(55.00)	χ²=6.08	0.014	0.692
肺出血后168小时内全因死亡[n(%)]	5(31.25)	25(62.50)	χ²=4.49	0.034	0.563
肺出血后702小时内全因死亡[n(%)]	7(43.75)	25(62.50)	χ²=1.64	0.200	0.249
肺出血后生存时间[M(P₂₅~P₇₅)]/h	888.50(108.50~1389.50)	34.00(6.00~1191.00)	Z=2.42	0.015	0.999

Therapeutic efficacy of surfactant supplementation after pulmonary hemorrhage in improving clinical outcomes of preterm infants with gestational age <34 weeks

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