机械通气对新生儿气道灌洗液中肺表面活性物质蛋白A的影响

Influence of mechanical ventilation on tracheal aspirate fluid surfactant-associated proteins-A levels in neonates

目的:观察机械通气对新生儿气道灌洗液中肺表面活性物质蛋白A(SP-A)的影响,探讨其在机械通气肺损伤中的作用及其临床意义。方法:将36例使用机械通气新生儿设为机械通气组,31例未使用机械通气新生儿设为非机械通气组,动态观察机械通气组患儿在机械通气后1 h、24 h、48 h、72 h气道灌洗液中SP-A在各时段的变化,非机械通气组也以同样时段气道灌洗液,用W estern dot b lot免疫印迹法检测气道灌洗液中SP-A水平。应用SPSS 10.0统计学软件进行统计学处理,所有数值以均数±标准差(x±s)表示;相关性分析应用直线相关公式计算关联系数r值。结果:机械通气组患儿气道灌洗液中SP-A水平显著降低,与非机械通气组比较差异有显著性(P<0.05,P<0.01),且SP-A水平与使用机械通气天数相关。机械通气后48 h气道灌洗液中SP-A水平出现明显变化,提示机械通气后48 h患儿可能开始出现肺损伤。结论:动态观察新生儿机械通气时气道灌洗液中SP-A水平可能有助于监测机械通气肺损伤的发生,对临床的诊断和治疗具有重要指导意义。

Objective： To explore the tracheal aspirate fluid surfactant - associated proteins - A （ SP - A） levels and the development of ventilation -induced lung injury （VILI） that occurs in neonate, and to investigate the effect of mechanical ventilation on tracheal aspirate fluid SP - A response of newborns. Methods： The study was carried out in 36 neonates used mechanical ventilation and in 31 neonates unused mechanical ventilation in Neonate Intensive Care Unit （NICU）. Tracheal aspirate fluid SP - A levels were observed dynamically in lh, 24h, 48h, 72h after using mechanical ventilation by western dot blot. Tracheal aspirate fluid SP - A levels in unusing mechanical ventilation group were determined at the same time. We took the statistic analysis with SPSS10. 0 statistic software. The All values were presented as mean ± SD （ x^-± s ） and the correlation analysis was taken with linear correlation formula. Results： Tracheal aspirate fluid SP - A levels in mechanical ventilation groups were obviously decreased than these of control group （ P 〈0. 05, P 〈0. 01, respectively）. We found that tracheal aspirate fluid SP -A levels correlated with the use of mechanical ventilation and the days requiring mechanical ventilation. Tracheal aspirate fluid SP - A levels in neonates on 48 h after mechanical ventilation had obviously changed. Conclusion： Tracheal aspirate fluid SP - A levels in neonates on 48h after mechanical ventilation may help us to monitor the development of VILI. Therefore, evaluating tracheal aspirate fluid SP - A levels in neonate after mechanical ventilation may help monitor the development of VILI and the clinical diagnosis and treatment of VILI.