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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2020年05期

页码:

623-627

栏目:

论著

出版日期:

2020-10-20

文章信息/Info

Title:

Effect of pulmonary surfactant combined with NCPAP on serum ET-1 and CC16 in neonates with respiratory failure

作者:

李俊兰¹; 张晓荣²

712000 咸阳,陕西省核工业二一五医院儿科¹ 519000 珠海市人民医院(暨南南大学附属珠海医院)儿科²

Author(s):

Li Junlan¹;  Zhang Xiaorong².

¹Department of Pediatrics, 215th Hospital of Shaanxi Nuclear Industry, Xian 712000 China; ²Department of Pediatrics, Zhuhai People's Hospital(Zhuhai Hospital affiliated to Jinan University), Zhuhai 519000 China

关键词:

肺表面活性物质;  鼻塞式正压通气;  新生儿呼吸衰竭;  内皮素-1;  Clara细胞蛋白-16

Keywords:

Pulmonary surfactant;  Nasal continuous positive airway pressure;  Neonatal respiratory failure;  ET-1;  CC16

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2020.05.009

摘要:

目的 探讨肺表面活性物质联合鼻塞式正压通气(NCPAP)对新生儿呼吸衰竭血清ET-1及CC16的影响。方法 选取2017年1月至2018年11月来院就诊患新生儿呼吸衰竭患儿共114例,采用随机数表分组随机分为观察组60例和对照组54例。两组患儿入组后均予对症治疗,对照组患儿予NCPAP,观察组患儿在此基础上加予肺表面活性物质治疗,均连续治疗3 d。比较两组总有效率、治疗前后的血清内皮素-1(ET-1)、Clara细胞蛋白-16(CC16)、血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、动脉血氧饱和度(SaO₂)以及不良反应发生率。结果 观察组总有效率81.67%(49/60),高于对照组64.81%(35/54),差异有统计学意义(P<0.05)。治疗后,两组患儿血清ET-1、CC16水平均明显降低,且观察组低于对照组(P<0.05)。治疗后两组患儿PaO₂、SaO₂均明显上升、PaCO₂明显下降(P<0.05)。观察组治疗后的PaO₂、SaO₂高于对照组,PaCO₂低于对照组,差异有统计学意义(P<0.05)。观察组和对照组不良反应发生率分别为8.33%(5/60)、9.26%(5/54),差异无统计学意义(P>0.05)。结论 新生儿呼吸衰竭采用肺表面活性物质联合NCPAP治疗效果更好,能有效降低血清ET-1及CC16水平。

Abstract:

Objective To investigate the effect of pulmonary surfactant combined with NCPAP on ET-1 and CC16 in neonates with respiratory failure. Methods from January 2017 to November 2018, a total of 117 patients with neonatal respiratory failure were randomly divided into two groups: observation group 60 cases and control group 54 cases. Both groups received routine nursing and symptomatic treatment. The control group was treated with NCPAP to control the symptoms of respiratory failure. The observation group was treated with pulmonary surfactant on this basis. The two groups were treated for 3 consecutive days. The changes of PaO₂, PaCO₂ and SaO₂ levels before and after treatment were compared After treatment, the adverse reactions of the two groups were recorded and counted. The changes of serum ET-1 and CC16 before and after treatment were compared. Results there was no significant difference in PaO₂, PaCO₂ and SaO₂ between the two groups before and after the treatment. The above indexes of the two groups were significantly improved after the treatment, and the patients in the observation group were significantly improved compared with the patients in the control group, the results were statistically significant(P<0.05); the total effective rate of the observation group was 82.46%, the total effective rate of the control group was 64.91%, the effective rate of the observation group was significantly higher than that of the control group, the results were There was statistical significance; there was no significant difference in the incidence of adverse reactions between the two groups; there was no significant difference in the expression of serum ET-1 and CC16 between the two groups before the treatment; after the treatment, the expression of serum ET-1 and CC16 in the two groups were significantly reduced, and the observation group was significantly lower than the control group, the results were statistically significant. Conclusion pulmonary surfactant combined with NCPAP is more effective in the treatment of neonatal respiratory failure, and can effectively reduce the expression of serum ET-1 and CC16.

参考文献/References:

1 刘 莉, 吕蓉蓉, 陈光耀, 等. 肺表面活性物质联合HFO对新生儿呼吸衰竭的疗效及对血清CK-MB、ET-1、Cys-C的影响[J]. 国际呼吸杂志, 2018, 38(13): 996-1000.
2 沈金鑫. 无创高频通气在新生儿呼吸衰竭中的应用[J]. 国际儿科学杂志, 2017, 44(12): 835-838.
3 Nikolopoulou M, Byraki A, Ahlberg J, et al. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnoea syndrome: a randomised, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems[J]. Journal of Oral Rehabilitation, 2017, 44(6): 452-460.
4 朱兴旺, 闫 军, 冉 琴, 等. 无创高频振荡通气治疗新生儿呼吸窘迫综合征的初步研究[J]. 中华新生儿科杂志(中英文), 2017, 32(4): 291-294.
5 李 静, 武瑞芳. 无创机械通气治疗阻塞性睡眠呼吸暂停低通气综合征的疗效及对患者血清炎性因子的影响[J]. 中国基层医药, 2018, 25(20): 2638-2641.
6 王 华, 母得志. 新生儿呼吸窘迫综合征的通气策略[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(1): 10-13.
7 周 海, 郏 琴. 重度COPD稳定期患者血清CC16、SP-D、MSP与患者肺功能、病情严重程度的关系[J]. 临床肺科杂志, 2019, 24(7): 1168-1171.
8 聂振清, 陈晓燕. 机械通气联合不同肺表面活性物质在新生儿呼吸窘迫综合征中的价值[J]. 安徽医药, 2019, 23(6): 1222-1225.
9 Smeeta Sardesai, Manoj Biniwale, Fiona Wertheimer, et al. Evolution of surfactant therapy for respiratory distress syndrome: past, present, and future[J]. Pediatr Res, 2017, 81(1-2): 240-248.
10 马加宝, 陈 凯. 临床新生儿学[M]. 山东科学技术出版社, 2002: 63-65.
11 Alapati D, Aghai ZH, Hossain MJ, et al. Lung Rest During Extracorporeal Membrane Oxygenation for Neonatal Respiratory Failure-Practice Variations and Outcomes[J]. Pediatric Critical Care Medicine, 2017, 18(7): 667-674.
12 Aldana-Aguirre JC, Pinto M, Featherstone RM, et al. Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(1): 17-23.
13 Zhu XW, Shi Y, Shi LP, et al. Non-invasive high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome: Study protocol for a multi-center prospective randomized controlled trial[J]. Trials, 2018, 19(1): 319-321.
14 Liu J, Wang Q, Qian SY, et al. Nasal continuous positive airway pressure ventilation in children with community-acquired pneumonia under five years of age: a prospective, multi-center clinical study[J]. Chinese Journal of Pediatrics, 2017, 55(5): 329-333.
15 Mamta Fuloria, Judy L Aschner. Persistent pulmonary hypertension of the newborn[J]. Semin Fetal Neonatal Med, 2017, 22(4): 220-226.
16 Yuan-Zeng HE, Wen-Feng W, Department IM. Effect of sequential mechanical ventilation on cardiac function,endothelial injury and oxidative stress response in patients with cor pulmonale[J]. Journal of Hainan Medical University, 2017, 23(15): 2029-2035.
17 Roberto Raschetti, Roberta Centorrino, Emmanuelle Letamendia, et al. Estimation of early life endogenous surfactant pool and CPAP failure in preterm neonates with RDS[J]. Respir Res, 2019, 20(1): 75-78.
18 Bernard Thébaud, Kara N Goss, Matthew Laughon, et al. Bronchopulmonary dysplasia[J]. Nat Rev Dis Primers, 2019, 5(1): 78-81.
19 Carlo Dani, Fabio Mosca, Giovanni Vento, et al. Effects of surfactant treatment in late preterm infants with respiratory distress syndrome[J]. J Matern Fetal Neonatal Med, 2018, 31(10): 1259-1266.
20 Niemarkt HJ, Hütten MC, Boris W Kramer, et al. Surfactant for Respiratory Distress Syndrome: New Ideas on a Familiar Drug with Innovative Applications[J]. Neonatology, 2017, 111(4): 408-414.
21 Takuji Suzuki, Bruce C Trapnell.Pulmonary Alveolar Proteinosis Syndrome[J]. Clin Chest Med, 2016, 37(3): 431-440.
22 Andrea Calkovska, Daniela Mokra, Vladimir Calkovsky, et al. Clinical considerations when treating neonatal aspiration syndromes[J]. Expert Rev Respir Med, 2019, 13(2): 193-203.
23 原 静, 李书芳, 李亚菲, 等. 不同机械通气方式治疗新生儿呼吸衰竭的效果及对患儿CC16、KL-6水平的影响[J]. 河北医科大学学报, 2019, 40(5): 551-555.
24 Ryushi Tazawa, Takahiro Ueda, Mitsuhiro Abe, et al. Inhaled GM-CSF for Pulmonary Alveolar Proteinosis[J]. N Engl J Med, 2019, 381(10): 923-932.
25 Anupam Kumar, Basem Abdelmalak, Yoshikazu Inoue, et al. Pulmonary alveolar proteinosis in adults: pathophysiology and clinical approach[J]. Lancet Respir Med, 2018, 6(7): 554-565.
26 Chong Woo Bae, Chae Young Kim, Sung Hoon Chung, et al. History of Pulmonary Surfactant Replacement Therapy for Neonatal Respiratory Distress Syndrome in Korea[J]. J Korean Med Sci, 2019, 34(25): 175-177.
27 Philip L Ballard, Roberta L Keller, William E Truog, et al. Surfactant status and respiratory outcome in premature infants receiving late surfactant treatment[J]. Pediatr Res, 2019, 85(3): 305-311.
28 Pavol Mikolka, Jana Kopincova, Petra Kosutova, et al. Anti-IL-8 antibody potentiates the effect of exogenous surfactant in respiratory failure caused by meconium aspiration[J]. Exp Lung Res, 2018, 44(1): 40-50.
29 韩宜均, 马文强. 呼吸机鼻塞式持续正压通气联合猪肺磷脂注射液对呼吸窘迫综合征新生儿动脉血气指标及症状改善的影响[J]. 新疆医学, 2018, 48(6): 615-617.
30 张纪伟. 肺表面活性物质治疗新生儿呼吸窘迫综合征的临床疗效分析[J]. 临床医学, 2017, 37(3): 113-114.
31 Bruce C Trapnell, Koh Nakata, Francesco Bonella, et al. Pulmonary alveolar proteinosis[J]. Nat Rev Dis Primers, 2019, 5(1):16-19.
32 Calum T Roberts, Louise S Owen, Brett J Manley, et al. Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants[J]. N Engl J Med, 2016, 375(12): 1142-1151.
33 Vincent Rigo, Caroline Lefebvre, Isabelle Broux. Surfactant instillation in spontaneously breathing preterm infants: a systematic review and meta-analysis[J]. Eur J Pediatr, 2016, 175(12): 1933-1942.

备注/Memo

备注/Memo:

基金项目: 陕西省社会发展科技攻关项目(2016SF-01987) 通信作者: 张晓荣, Email: 472340412@qq.com

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更新日期/Last Update: 2020-10-20