容量目标通气联合肺泡表面活性物质治疗新生儿呼吸窘迫综合征的疗效分析
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摘要
目的探讨肺泡表面活性物质联合容量目标通气治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法选取2014年1月—2017年3月资阳市第一人民医院收治的NRDS患儿42例,参照随机数字表法将患儿分为对照组及研究组。对照组患儿接受常规治疗+容量目标通气治疗,研究组患儿接受常规治疗+容量目标通气+肺泡表面活性物质治疗。比较两组患儿治疗前及治疗1周后动脉血气指标水平、Th1/Th2细胞因子含量及心肌损伤标志物含量的差异。结果两组治疗1周后的动脉血氧分压(PaO_2)、氧合指数(OI)、血氧饱和度(SpO_2)及血清白细胞介素-4(IL-4)较治疗前升高(P<0.05),而二氧化碳分压(PaCO_2)、血清干扰素-γ(IFN-γ)、肌钙蛋白Ⅰ(cTnI)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)含量及IFN-γ/IL-4水平较治疗前降低(P<0.05)。研究组患儿治疗1周后Pa O2、OI、SpO2及IL-4较对照组升高(P<0.05),而PaCO2、IFN-γ、IFN-γ/IL-4、cTnI、CK-MB及LDH较对照组降低(P<0.05)。结论 NRDS患儿接受肺泡表面活性物质联合容量目标通气治疗,可有效优化通气功能并减轻全身炎症状态,抑制心肌损伤。
Objective To study the effect of pulmonary surfactant combined with volume target ventilation in the treatment of neonatal respiratory distress syndrome(NRDS). Methods A total of 42 cases of NRDS in our hospital during January 2014 to March 2017 were chosen as research subject, and all patients were divided into control group and study group each with 21 cases according to the random number table method. Patients in control group were treated with routine treatment + volume target ventilation(VTV) treatment, and those in study group were treated with routine treatment + VTV + pulmonary surfactant. The differences of arterial blood gas indexes, Th1/Th2 cytokine contents and myocardial damage markers were compared between two groups before and after one-week treatment. Results After one week of treatment, the arterial partial pressure of oxygen(PaO_2), oxygenation index(OI), blood oxygen saturation(SpO2) and serum interleukin-4(IL-4) levels of two groups increased, while the partial pressure of carbon dioxide(PaCO2) and serum interferon-γ(IFN-γ), troponin I(cTnI), creatine kinase isoenzyme(CKMB) contents and IFN-γ/IL-4 level decreased(P < 0.05). Compared with the control group, the elevation of PaO_2,OI, SpO_2 and IL-4 were higher(P < 0.05), and PaCO_2, IFN-γ, IFN-γ/IL-4, cTnI, CK-MB and LDH were significantly increased in the observation group one week after treatment(P < 0.05). Conclusions The treatment of NRDS with pulmonary surfactant combines with VTV can effectively optimize the ventilation function, and reduce the state of systemic inflammation and inhibit myocardial injury.
Objective To study the effect of pulmonary surfactant combined with volume target ventilation in the treatment of neonatal respiratory distress syndrome(NRDS). Methods A total of 42 cases of NRDS in our hospital during January 2014 to March 2017 were chosen as research subject, and all patients were divided into control group and study group each with 21 cases according to the random number table method. Patients in control group were treated with routine treatment + volume target ventilation(VTV) treatment, and those in study group were treated with routine treatment + VTV + pulmonary surfactant. The differences of arterial blood gas indexes, Th1/Th2 cytokine contents and myocardial damage markers were compared between two groups before and after one-week treatment. Results After one week of treatment, the arterial partial pressure of oxygen(PaO_2), oxygenation index(OI), blood oxygen saturation(SpO2) and serum interleukin-4(IL-4) levels of two groups increased, while the partial pressure of carbon dioxide(PaCO2) and serum interferon-γ(IFN-γ), troponin I(cTnI), creatine kinase isoenzyme(CKMB) contents and IFN-γ/IL-4 level decreased(P < 0.05). Compared with the control group, the elevation of PaO_2,OI, SpO_2 and IL-4 were higher(P < 0.05), and PaCO_2, IFN-γ, IFN-γ/IL-4, cTnI, CK-MB and LDH were significantly increased in the observation group one week after treatment(P < 0.05). Conclusions The treatment of NRDS with pulmonary surfactant combines with VTV can effectively optimize the ventilation function, and reduce the state of systemic inflammation and inhibit myocardial injury.
引文
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[12]OTSUBO Y,HASHIMOTO K,KANBE T,et al.Association of cord blood chemokines and other biomarkers with neonatal complications following intrauterine inflammation[J].PLoS One,2017,12(5):DOI:10.1371/journal.pone.0175082.
[13]HELMO F R,ALVES E A R,MOREIRA R A A,et al.Intrauterine infection,immune system and premature birth[J].J Matern Fetal Neonatal Med,2017,20(8):1-7.
[14]CATLIN E A,WARREN H S,SHAILAM R,et al.Case records of the Massachusetts General Hospital.Case 19-2012.A premature newborn boy with respiratory distress[J].N Engl J Med,2012,366(25):2409-2419.
[15]王亮君,李菁,孙建华.动脉导管未闭新生儿血清肌钙蛋白Ⅰ,磷酸肌酸激酶及其杂化型的表达与意义[J].中国医药导报,2016,13(26):84-87.
[16]冯琼.纳洛酮对新生儿呼吸窘迫综合征后氧化应激的影响及心肌损害的保护作用[J].临床肺科杂志,2016,21(8):1391-1394.
[17]LIMBACH H G,HASENFUS A,BOHLE R M,et al.Severe respiratory distress syndrome unresponsive to intensive care treatment--diagnostic and therapeutic considerations[J].Klin Padiatr,2011,223(5):283-286.
[2]CROWTHER C A,ASHWOOD P,MCPHEE A J,et al.Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome(the PROGRESS Study):a multicentre,randomised,placebocontrolled trial[J].PLoS Med,2017,14(9):DOI:10.1371/journal.pmed.1002390.
[3]张立生,崔凯洁.肺泡表面活性物质联合容量目标通气治疗NRDS的疗效分析[J].中国医药导刊,2016,18(11):1126-1130.
[4]ROJAS-REYES M X,ORREGO-ROJAS P A.Rescue highfrequency jet ventilation versus conventional ventilation for severe pulmonary dysfunction in preterm infants[J].Cochrane Database Syst Rev,2015,(10):DOI:10.1002/14651858.CD000437.pub3.
[5]中华医学会呼吸病学分会.急性肺损伤/急性呼吸窘迫综合征的诊断标准(草案)[J].中华结核和呼吸杂志,2000,23(4):203.
[6]刘郴州,黄碧茵,谭宝莹,等.容量目标通气治疗新生儿呼吸窘迫综合征的疗效[J].中国当代儿科杂志,2016,18(1):6-9.
[7]ISCAN B,DUMAN N,TUZUN F,et al.Impact of volume guarantee on high-frequency oscillatory ventilation in preterm infants:a randomized crossover clinical trial[J].Neonatology,2015,108(4):277-282.
[8]COOLS F,OFFRINGA M,ASKIE L M.Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants[J].Cochrane Database Syst Rev,2015,(3):DOI:10.1002/14651858.CD000104.pub4.
[9]ZHANG C,ZHU X.Clinical effects of pulmonary surfactant in combination with nasal continuous positive airway pressure therapy on neonatal respiratory distress syndrome[J].Pak J Med Sci,2017,33(3):621-625.
[10]ZHOU B,ZHAI J F,WU J B,et al.Different ventilation modes combined with ambroxol in the treatment of respiratory distresssyndrome in premature infants[J].Exp Ther Med,2017,13(2):629-633.
[11]翟淑芬,刘翠青,平莉莉,等.肺表面活性物质对新生儿呼吸窘迫综合征患儿血清Th1/Th2平衡的影响[J].中国当代儿科杂志,2012,14(12):893-896.
[12]OTSUBO Y,HASHIMOTO K,KANBE T,et al.Association of cord blood chemokines and other biomarkers with neonatal complications following intrauterine inflammation[J].PLoS One,2017,12(5):DOI:10.1371/journal.pone.0175082.
[13]HELMO F R,ALVES E A R,MOREIRA R A A,et al.Intrauterine infection,immune system and premature birth[J].J Matern Fetal Neonatal Med,2017,20(8):1-7.
[14]CATLIN E A,WARREN H S,SHAILAM R,et al.Case records of the Massachusetts General Hospital.Case 19-2012.A premature newborn boy with respiratory distress[J].N Engl J Med,2012,366(25):2409-2419.
[15]王亮君,李菁,孙建华.动脉导管未闭新生儿血清肌钙蛋白Ⅰ,磷酸肌酸激酶及其杂化型的表达与意义[J].中国医药导报,2016,13(26):84-87.
[16]冯琼.纳洛酮对新生儿呼吸窘迫综合征后氧化应激的影响及心肌损害的保护作用[J].临床肺科杂志,2016,21(8):1391-1394.
[17]LIMBACH H G,HASENFUS A,BOHLE R M,et al.Severe respiratory distress syndrome unresponsive to intensive care treatment--diagnostic and therapeutic considerations[J].Klin Padiatr,2011,223(5):283-286.