经鼻间歇正压通气联合大剂量牛肺表面活性剂治疗重症新生儿呼吸窘迫综合征的疗效

Efficacy of pernasal intermittent positive pressure ventilation combined with high-dose bovine lung surfactant in the treatment of severe neonatal respiratory distress syndrome

目的观察经鼻间歇正压通气(NIPPV)联合大剂量牛肺表面活性剂治疗重症新生儿呼吸窘迫综合征(NRDS)的疗效,探讨对患儿血清白细胞介素-6(IL-6)、骨形态发生蛋白-7(BMP-7)、转化生长因子-β1(TGF-β1)表达水平的影响。方法选择78例重症NRDS患儿作为研究对象,按随机数字表法分为研究组和对照组,每组39例。2组均在常规治疗基础上给予NIPPV,且研究组加用大剂量牛肺表面活性剂。比较2组疗效、氧疗时间、机械通气时间、住院时间、疾病相关并发症发生率、治疗前后血清IL-6、BMP-7、TGF-β1水平,并比较2组血气指标动脉血氧分压[p a(O 2)]、动脉血二氧化碳分压[p a(CO 2)]、pH值。治疗后随访至校正18月龄,比较2组肺功能指标[潮气量(VT)、达峰容积比(VPEF/VE)、达峰时间比(TPTEF/TE)、呼吸频率(RR)]水平。结果治疗后,研究组总有效率显著高于对照组,疾病相关并发症发生率显著低于对照组(P<0.05);研究组氧疗时间、机械通气时间、住院时间显著短于对照组(P<0.05);治疗后,2组p a(O 2)、pH值水平较治疗前显著升高(P<0.05),p a(CO 2)与血清IL-6、BMP-7、TGF-β1水平较治疗前显著降低(P<0.05),且研究组以上指标变化幅度均显著大于对照组(P<0.05);随访至校正18月龄,研究组VT、VPEF/VE、TPTEF/TE水平显著高于对照组(P<0.05),RR水平显著低于对照组(P<0.05)。结论采用NIPPV联合大剂量牛肺表面活性剂治疗重症NRDS可改善患儿血气情况,降低血清IL-6、BMP-7、TGF-β1表达水平,减轻炎症反应,减少并发症,改善肺功能,促进患儿康复。

Objective To observe the efficacy of pernasal intermittent positive pressure ventilation(NIPPV)combined with high-dose bovine lung surfactant in the treatment of severe neonatal respiratory distress syndrome(NRDS)and explore its effects on the expressions of serum interleukin-6(IL-6),bone morphogenetic protein-7(BMP-7),and transforming growth factor-β1(TGF-β1).Methods A total of 78 children with severe NRDS were selected as research objects and were divided into study group(n=39)and control group(n=39)according to the random number table method.Patients in both groups were all given NIPPV on the basis of conventional treatment,and the study group was given high-dose bovine lung surfactant.The efficacy,oxygen therapy time,mechanical ventilation time,length of hospital stay,incidence of disease-related complications,and levels of serum IL-6,BMP-7,TGF-β1 before and after treatment were compared.Besides,partial pressure of carbon dioxide in arterial blood[p a(O 2)],partial pressure of carbon dioxide in arterial blood[p a(CO 2)],and pH value of the two groups were compared.The neonates were followed up to eighteen months of adjusted age after treatment,lung function indicators[tidal volume(VT),ratio of volume to peak expiratory flow(VPEF)to total expiratory volume(VE)(VPEF/VE),ratio of time to peak tidal expiratory flow(TPTEF)to total expiratory time(TE)(TPTEF/TE),and respiratory rate(RR)]were compared between the two groups.Results After treatment,the total effective rate in the study group was significantly higher than that in the control group,the incidence of disease-related complications was significantly lower than that in the control group(P<0.05);the oxygen treatment time,mechanical ventilation time,and hospital stay of the study group were significantly shorter than those of the control group(P<0.05);after treatment,the levels of p a(O 2)and pH value in the two groups were significantly higher than before treatment(P<0.05),and p a(CO 2)as well as serum IL-6,BMP-7,TGF-β1 levels were significantly lower than those before treatment,and the change degrees of above indicators in the study group were significantly more than the control group(P<0.05).Follow-up to adjusted eighteen months of age showed that the levels of VT,VPEF/VE,TPTEF/TE in the study group were significantly higher than those in the control group,and the RR level was significantly lower than that in the control group(P<0.05).Conclusion NIPPV combined with high-dose bovine lung surfactant can improve blood gas in children with severe NRDS,reduce the expressions of serum IL-6,BMP-7 and TGF-β1,and relieve the inflammatory reactions.Besides,it can reduce the occurrence of disease complications,improve the lung function and promote the recovery of children.