高频振荡通气联合肺表面活性剂治疗极低出生体质量儿呼吸窘迫综合征疗效及对其肺功能和血清IL-6、甲状腺激素浓度的影响

Curative effect of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of respiratory distress syndrome in very low birth weight infants and the influence on pulmonary function,serum IL-6 and thyroid hormone concentration

目的研究高频振荡通气(HFOV)联合肺表面活性剂(PS)治疗极低出生体质量儿呼吸窘迫综合征(NRDS)的疗效及对其肺功能和血清IL-6、甲状腺激素浓度的影响。方法选取92例NRDS极低出生体质量儿作为研究对象,随机分为对照组和观察组各46例,两组均给予PS治疗,观察组在此基础上加用HFOV治疗,观察并记录两组临床疗效、肺功能指标、治疗前后血气分析指标、血清IL-6、甲状腺激素浓度变化情况及并发症发生率。结果观察组临床疗效总有效率明显高于对照组(P<0. 05);治疗后两组吸入氧浓度(FiO_2)、动脉血二氧化碳分压(PaCO_2)较治疗前均明显下降(P<0. 05),而p H、动脉血氧分压(PaO_2)明显升高(P<0. 05),且观察组各指标变化幅度明显高于对照组(P<0. 05);观察组肺功能指标达峰时间比(TPEF/TE)、达峰容积比(VPEF/VE)及体质量潮气量(VT)均明显高于对照组(P<0. 05);治疗后两组血清IL-6水平较治疗前均明显降低(P<0. 05),T_3、FT_3、T_4、FT_4、r T_3水平明显升高(P<0. 05),且观察组各因子水平变化幅度均大于对照组(P<0. 05),两组TSH水平治疗前后差异无统计学意义(P> 0. 05);观察组并发症发生率明显低于对照组(P<0. 05)。结论HFOV联合PS治疗NRDS极低出生体质量儿疗效显著,能够改善患儿血气状态及氧合,减少肺损伤,降低血清IL-6水平,调节甲状腺激素浓度,且并发症发生风险小,安全性较高。

Objective To research the curative effect of high-frequency oscillatory ventilation(HFOV)combined with pulmonary surfactant(PS)in treatment of respiratory distress syndrome(NRDS)in very low birth weight infants and the influence on pulmonary function,serum IL-6 and thyroid hormone concentrations.Methods Ninety-two very low birth weight infants with NRDS were selected as study object,then they were randomly divided into control group and observation group,46 infants in each group.The infants in the two groups were given PS treatment,and the infants in observation group were treated with HFOV.The clinical effects,pulmonary function indexes,blood gas analysis indexes,serum IL-6 and thyroid hormone concentrations before and after treatment,incidence rates of complications in the two groups were observed and recorded.Results The total effective rate in observation group was statistically significantly higher than that in control group(P<0.05).After treatment,FiO2 and PaCO2 in the two groups were statistically significantly lower than those before treatment(P<0.05),pH and PaO2 were statistically significantly higher than those before treatment(P<0.05).The amplitudes of variation of different indexes in observation group were statistically significantly higher than those in control group(P<0.05).TPEF/TE,VPEF/VE,and VT in observation group were statistically significantly higher than those in control group(P<0.05).In the two groups,serum IL-6 levels after treatment were statistically significantly lower than those before treatment(P<0.05),the levels of T3,FT3,T4,FT4,and rT3 increased significantly(P<0.05).The amplitudes of variation of different indexes in observation group were statistically significantly larger than those in control group(P<0.05).There was no statistically significant difference in TSH level between before and after treatment in the two groups(P>0.05).The incidence rate of complications in observation group was statistically significantly lower than that in control group(P<0.05).Conclusion The curative effect of HFOV combined with PS in treatment of very low birth weight infants with NRDS is significant,the therapy can improve blood gas status and oxygenation,reduce lung injury and serum IL-6 level,regulate thyroid hormone concentration,and the risk of complications is small,the safety is high.