牛肺表面活性物质治疗新生儿胎粪吸入综合征的疗效研究
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摘要
目的探究牛肺表面活性物质在胎粪吸入炎症感染新生儿中的应用效果。方法选取2016年1月-2017年12月在医院接受治疗的82例胎粪吸入综合征新生患儿作为研究对象,按照随机数表法分为对照组和研究组,每组41例。对照组患儿采用常规治疗,研究组患儿在对照组患儿的治疗基础上采用牛肺表面活性物质进行治疗。比较两组患儿接受治疗前后炎症指标白细胞介素-8(IL-8)和白细胞介素-10(IL-10)水平,治疗后不同时刻患儿的动脉氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合功能指数(OI)和动脉/肺泡氧分压(a/APO2)水平,患儿机械通气时长、住院时长以及并发症情况。结果研究组患儿治疗24h后IL-8低于对照组,IL-10水平高于对照组(均P<0.05);治疗后不同时刻两组患儿PaO2和a/APO2水平均升高,PaCO2和OI水平均降低,且研究组优于对照组(P<0.05);研究组患儿机械通气时间(82.26±18.34)h,住院时间(10.86±2.71)d均短于对照组的(121.34±21.17)h和(18.09±3.35)d,两组比较差异有统计学意义(P<0.05);患儿均出现间质性肺炎和肺出血并发症。结论牛肺表面活性物质应用于胎粪吸入炎症感染患儿常规治疗中可改善患儿肺部氧合功能,缩短机械通气时长和住院时长,降低患儿并发症,具有良好的临床使用价值。
OBJECTIVE To explore the effect of bovine pulmonary surfactant on treatment of neonates with meconium aspiration syndrome.METHODS A total of 82 neonates with meconium aspiration syndrome who were treated in the hospital from Jan 2016 to Dec 2017 were recruited as the study objects and randomly divided into the study group and the control group,with 41 cases in each group.The control group was given conventional therapy,while the study group was treated with bovine pulmonary surfactant on basis of the treatment of the control group.The levels of inflammatory indexes interleukin-8(IL-8)and interleukin-10(IL-10)were compared between the two groups of neonates before and after the treatment;the partial pressure of arterial oxygen(PaO2),partial pressure of arterial carbon dioxide(PaCO2),oxygenation function index(OI)and arterial/alveolar oxygen partial pressure(a/APO2)of the neonates were observed after the treatment for different time periods;the mechanical ventilation duration,length of hospital stay and incidence of complications were compared between the two groups of neonates.RESULTS The IL-8 level of the study group was significantly lower than that of the control group after the treatment for 24 hours,while the IL-10 level of the study group was significantly higher than that of the control group(all P<0.05).The levels of PaO2 and a/APO2 of the two groups of neonates were elevated after the treatment for different time periods,while the levels of PaCO2 and OI were reduced,and the levels of the above indexes changed more significantly in the study group than in the control group(P<0.05).The mechanical ventilation duration of the study group was(82.26±18.34)h,significantly shorter than(121.34±21.17)h of the control group;the length of hospital stay of the study group was(10.86±2.71)d,significantly shorter than(18.09±3.35)d of the control group(P<0.05).Both groups of neonates had interstitial pneumonia and pneumorrhagia.CONCLUSIONBovine pulmonary surfactant may improve the pulmonary oxygenation function of the neonates with meconium aspiration syndrome,shorten the mechanical ventilation and length of hospital stay and reduce the incidence of complications,with the clinical value high.
OBJECTIVE To explore the effect of bovine pulmonary surfactant on treatment of neonates with meconium aspiration syndrome.METHODS A total of 82 neonates with meconium aspiration syndrome who were treated in the hospital from Jan 2016 to Dec 2017 were recruited as the study objects and randomly divided into the study group and the control group,with 41 cases in each group.The control group was given conventional therapy,while the study group was treated with bovine pulmonary surfactant on basis of the treatment of the control group.The levels of inflammatory indexes interleukin-8(IL-8)and interleukin-10(IL-10)were compared between the two groups of neonates before and after the treatment;the partial pressure of arterial oxygen(PaO2),partial pressure of arterial carbon dioxide(PaCO2),oxygenation function index(OI)and arterial/alveolar oxygen partial pressure(a/APO2)of the neonates were observed after the treatment for different time periods;the mechanical ventilation duration,length of hospital stay and incidence of complications were compared between the two groups of neonates.RESULTS The IL-8 level of the study group was significantly lower than that of the control group after the treatment for 24 hours,while the IL-10 level of the study group was significantly higher than that of the control group(all P<0.05).The levels of PaO2 and a/APO2 of the two groups of neonates were elevated after the treatment for different time periods,while the levels of PaCO2 and OI were reduced,and the levels of the above indexes changed more significantly in the study group than in the control group(P<0.05).The mechanical ventilation duration of the study group was(82.26±18.34)h,significantly shorter than(121.34±21.17)h of the control group;the length of hospital stay of the study group was(10.86±2.71)d,significantly shorter than(18.09±3.35)d of the control group(P<0.05).Both groups of neonates had interstitial pneumonia and pneumorrhagia.CONCLUSIONBovine pulmonary surfactant may improve the pulmonary oxygenation function of the neonates with meconium aspiration syndrome,shorten the mechanical ventilation and length of hospital stay and reduce the incidence of complications,with the clinical value high.
引文
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[11]徐鸣浩,刘成军,许峰,等.高频振荡通气联合肺表面活性物质治疗重症胎粪吸入综合征的临床研究[J].中华临床医师杂志(电子版),2015,9(18):3457-3460.
[12]卢安庭.肺表面活性物质治疗新生儿胎粪吸入综合征的临床观察分析[J].中国医药导刊,2014,16(1):82-83.
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[14] Salvesen B,Curstedt T,Mollnes TE,et al.Effects of natural versus synthetic surfactant with SP-B and SP-C analogs in a porcine model of meconium aspiration syndrome[J].Neonatology,2014,105(2):128-135.
[15]王敏智,何柳芳.小剂量牛肺表面活性物质结合高频震荡通气对新生儿呼吸衰竭临床症状及呼吸状态的改善效果观察[J].安徽医学,2016,37(1):5-8.
[16] Akella A,Deshpande SB.Pulmonary surfactants and their role in pathophysiology of lung disorders[J].Indian J Exp Biol,2013,51(1):5-22.
[17]寿文祥.32例新生儿呼吸机相关性肺炎的临床分析[J].中华医院感染学杂志,2012,22(4):731-732.
[18] Polin RA,Carlo WA,Papile LA,et al.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.
[19]陈海华.猪肺磷脂与牛肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效比较[J].临床肺科杂志,2015,20(1):55-57,58.
[20] Mokra D,Mokry J,Tonhajzerova I.Anti-inflammatory treatment of meconium aspiration syndrome:benefits and risks[J].Respir Physiol Neurobiol,2013,187(1):52-57.
[2] Kurland G,Deterding RR,Hagood JS,et al.An official American Thoracic Society clinical practice guideline:classification,evaluation,and management of childhood interstitial lung disease in infancy[J].Am J Respir Crit Care Med,2013,188(3):376-394.
[3]郑俊虎,郑骆颖,王大化,等.羊水粪染及与羊膜腔感染的关系[J].中华医院感染学杂志,2013,23(8):1846-1847.
[4] Mokra D,Drgova A,Kopincova J,et al.Anti-inflammatory treatment in dysfunction of pulmonary surfactant in meconium-induced acute lung injury[J].Adv Exp Med Biol,2013,756:189-196.
[5]吴俊超,杨静清,刘军民,等.重症胎粪吸入综合征分型特征及其预判指标研究[J].中华妇幼临床医学杂志(电子版),2015,11(6):774-779.
[6]米果,熊淑杰.肺表面活性物质治疗胎粪吸入综合征合并呼吸衰竭的疗效研究[J].中国妇幼保健,2014,29(20):3280-3281.
[7] Lindenskov PH,Castellheim A,Saugstad OD,et al.Meconium aspiration syndrome:possible pathophysiological mechanisms and future potential therapies[J].Neonatology,2015,107(3):225-230.
[8]赵冰,潘家华.不同肺表面活性物质治疗新生儿呼吸窘迫综合征疗效比较[J].中国新生儿科杂志,2014,29(3):158-161.
[9]Mokra D,Calkovska A.How to overcome surfactant dysfunction in meconium aspiration syndrome[J].Respir Physiol Neurobiol,2013,187(1):58-63.
[10] Benkoe T,Reck C,Pones M,et al.Interleukin-8predicts60-day mortality in premature infants with necrotizing enterocolitis[J].J Pediatr Surg,2014,49(3):385-389.
[11]徐鸣浩,刘成军,许峰,等.高频振荡通气联合肺表面活性物质治疗重症胎粪吸入综合征的临床研究[J].中华临床医师杂志(电子版),2015,9(18):3457-3460.
[12]卢安庭.肺表面活性物质治疗新生儿胎粪吸入综合征的临床观察分析[J].中国医药导刊,2014,16(1):82-83.
[13] Tadokera R,Wilkinson KA,Meintjes GA,et al.Role of the interleukin 10family of cytokines in patients with immune reconstitution inflammatory syndrome associated with HIV infection and tuberculosis[J].J Infect Dis,2013,207(7):1148-1156.
[14] Salvesen B,Curstedt T,Mollnes TE,et al.Effects of natural versus synthetic surfactant with SP-B and SP-C analogs in a porcine model of meconium aspiration syndrome[J].Neonatology,2014,105(2):128-135.
[15]王敏智,何柳芳.小剂量牛肺表面活性物质结合高频震荡通气对新生儿呼吸衰竭临床症状及呼吸状态的改善效果观察[J].安徽医学,2016,37(1):5-8.
[16] Akella A,Deshpande SB.Pulmonary surfactants and their role in pathophysiology of lung disorders[J].Indian J Exp Biol,2013,51(1):5-22.
[17]寿文祥.32例新生儿呼吸机相关性肺炎的临床分析[J].中华医院感染学杂志,2012,22(4):731-732.
[18] Polin RA,Carlo WA,Papile LA,et al.Surfactant replacement therapy for preterm and term neonates with respiratory distress[J].Pediatrics,2014,133(1):156-163.
[19]陈海华.猪肺磷脂与牛肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效比较[J].临床肺科杂志,2015,20(1):55-57,58.
[20] Mokra D,Mokry J,Tonhajzerova I.Anti-inflammatory treatment of meconium aspiration syndrome:benefits and risks[J].Respir Physiol Neurobiol,2013,187(1):52-57.