新生儿机械通气时检测血浆及气道灌洗液中SP-A的意义

The clinical significance of plasma and tracheal aspirate fluid surfactant-associated proteins-A levels in neonates on mechanical ventilation

目的观察机械通气对新生儿血浆及气道灌洗液(BALF)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、24、48、72 h和撤机后24 h血浆中SP-A及在机械通气后1、24、487、2 h BALF中SP-A在各时段的变化,非机械通气组也以同样时段采集静脉血及BALF,用Western dot blot免疫印迹法检测血浆及BALF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血浆中SP-A水平明显升高,BALF中SP-A水平显著降低,与非机械通气组比较差异有显著性意义(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血浆及BALF中SP-A水平出现明显变化,随着病情好转撤机,血浆中SP-A水平逐渐回落,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血浆及BALF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 relationship between surfactant-associated protein-A（SP-A） of plasma and tracheal aspirate fluid（BALF）of and the development of ventilation-induced lung injury（VILI）that occurs in neonate. We investigated the effect of mechanical ventilation on plasma and BALF SP-A response of newborns. Methods The study was carried out in 36 neonates on mechanical ventilation and 31 neonates without mechanical ventilation in neonate intensive care unit（NICU）. Plasma SP-A levels were observed dynamically in 1 h, 24 h, 48 h, 72 h after initiation of mechanical ventilation and 24 h to removed mechanical ventilation, and BALF SP-A levels were observed dynamically at 1 h, 24 h, 48 h, 72 h after initiation of mechanical ventilation by western-dot blot. Plasma and BALF SP-A levels in non-mechanical ventilation group were determined at the same time. We took the statistic analysis with SPSS10.0 statistic software. All values were presented as（x ± s）and the correlative analysis was taken with linear correlation formula. Results Plasma SP-A levels in mechanical ventilation groups were significantly higher than those of control group（respectively, P 〈 0.05, P 〈 0.01）. BALF SP-A levels in mechanical ventilation groups were obviously decreased than these of control group （respectively, P 〈 0.05, P 〈 0.01 ）. We found that plasma and BALF SP-A levels correlated with mechanical ventilation and the days requiring mechanical ventilation. Plasma and BALF SP-A levels in neonates at 48 h after mechanical ventilation had obviously changed. Conclusion Plasma and BALF SP-A levels in neonates at 48 h after mechanical vent-ilation may help us to monitor the development of VILI. Therefore, evaluating plasma and BALF SP-A levels in neonate after mechanical ventilation may help monitor the development of VILI and the clinical diagnosis and treatment of VILI.