经鼻高流量湿化氧疗对新生儿肺炎血清CRP、PCT、IL-6水平的影响

Effects of transnasal high flow humidified oxygen therapy on the serum levels of CRP,PCT and IL6 in neonates with pneumonia

目的探讨经鼻高流量湿化氧疗(humidified high flow nasal cannula oxygen therapy,HFNC)治疗对新生儿肺炎患儿血清CRP、PCT、IL-6水平的影响。方法选择2017年1月至2018年12月收治的新生儿肺炎患儿116例为研究对象,采用随机数字表法分为观察组和对照组,每组58例。对照组患儿采用经鼻持续气道正压通气(CPAP)治疗,观察组采用HFNC治疗,对比观察2组患儿治疗前后临床症状、72h舒适度、痰液粘稠度、动脉血气指标及血清C反应蛋白(C-reactive protein,CRP)、白介素-6(IL-6)、降钙素原(procalcitonin,PCT)水平变化。结果观察组患儿心率恢复、呼吸困难缓解、肺啰音消失等临床症状改善时间均明显少于对照组,差异有统计学意义(t=9.862,18.193,12.439,P<0.05)。治疗后,2组动脉血氧分压(PaO2)、动脉/肺泡氧分压(a/APO2)水平均显著提高,动脉二氧化碳分压(PaCO2)、呼吸频次水平显著降低,且观察组各血气指标改善幅度均大于对照组(P<0.05);观察组患儿12、24、48 h时的舒适度评分及痰液粘稠度均明显优于对照组(P<0.05或<0.01);治疗后,3组患儿血清中CRP、IL-6、PCT水平明显减低,且观察组明显低于对照组(P<0.05);观察组喂养不耐受(8.62%)、鼻部压疮(3.45%)、气胸发生率(0)明显低于对照组的17.24%、10.34%、5.17%(χ^2=5.998,P<0.05)。结论新生儿肺炎采用HFNC湿化氧疗,能够显著改善患儿呼吸困难,抑制CRP、PCT、IL-6等炎性因子释放,进而提高治疗舒适度及气道湿化效果,促进疾病临床症状恢复,值得临床推广。

Objective To investigate the effects of transnasal high flow humidified oxygen therapy(HFNC)on the serum levels of CRP,PCT and IL-6 in neonates with pneumonia.Methods A total of 116 patients with neonatal pneumonia,who were treated in our hospital from July 2017 to October 2018,were randomly divided into observation group(n=58)and control group(n=58).The patients in control group were treated by transnasal continuous positive airway pressure(CPAP),however,the patients in observation group were treated by transnasal HFNC.The clinical symptoms,72h comfort level,sputum viscosity,arterial blood gas index,serum Creactive protein(CRP),interleukin6(IL-6),procalcitonin(PCT)levels before and after treatment were observed and compared between the two groups.Results The improvement time of clinical symptoms including heart rate recovery,dyspnea relief and lung rale disappearance in observation group was significantly shorter than that in control group(P<0.05).After treatment,the levels of arterial partial pressure of oxygen(PaO2)and arterial/alveolar partial pressure of oxygen(a/APO2)in both groups significantly increased,while the levels of arterial partial pressure of carbon dioxide(PaCO2),respiratory frequency were significantly decreased.And the improvement degree of blood gas indexes in observation group was more significant than that in control group(P<0.05).Moreover,the comfort scores and sputum viscosity in observation group at 12h,24h and 48h were significantly better than those in control group(P<0.05 or P<0.01).Furthermore,the serum levels of CRP,IL-6 and PCT in both groups were significantly decreased,moreover,which in observation group were significantly lower than those in control group(P<0.05).In addition,the feeding intolerance,nasal pressure sore and the incidence of pneumothorax of the patients in observation group were 8.62%,3.45%and 0,which were significantly lower than those(17.24%,10.34%,5.17%)in control group(P<0.05).Conclusion HFNC can significantly improve the dyspnea of neonates with pneumonia,inhibit the release of inflammatory factors including CRP,PCT,IL-6,so as to improve the treatment comfort degree and airway humidification effect to promote the recovery of clinical symptoms,thus,it is worthy of popularization.