Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Surfactant Protein B 1580 Polymorphism Is Associated with Susceptibility to Chronic Obstructive Pulmonary Disease in Chinese Han Population

Summary: Whether surfactant protein B (SP-B)-18A/C and 1580C/T polymorphism were associated with susceptibility to chronic obstructive pulmonary disease (COPD) in Chinese Han population was investigated. After genomic DNA was isolated from blood of COPD smokers and control smokers, the genotypes of SP-B-18A/C and SP-B1580C/T polymorphism loci were determined by polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP) respectively. The results showed that there was significant difference in genotypes distribution frequency of SP-B1580C/T polymorphism locus between COPD smokers and control smokers. C→T mutation rate (including TT homozygote and CT heterozygote) in COPD smokers was higher than in control smokers (57.9 % vs 41.7 %, χ2=4.93, P<0.05), whereas there was no significant difference in genotypes distribution frequency of SP-B1580-18A/C locus between COPD smokers and control smokers. The allele frequency (29.1 %) of SP-B1580-18A/C locus is lower than T allele (70.9 %) in Chinese Han Population, and the distribution was different from that in Mexican, in which, the A and T allele frequencies were 85 % and 15 % respectively. It was concluded that SP-B1580 T allele was probably associated with increased susceptibility to COPD in Chinese Han population; The polymorphism of SP-B-18A/C locus maybe varied with race.

Early Intratracheal Administration of Corticosteroid and Pulmonary Surfactant for Preventing Bronchopulmonary Dysplasia in Preterm Infants with Neonatal Respiratory Distress Syndrome: A Meta-analysis

There is uncertain result with regard to the use of inhalation or instillation steroids to prevent bronchopulmonary dysplasia in preterm infants. This meta-analysis was designed to evaluate the efficacy and safety of early airway administration (within 2 days after birth) of corticosteroids and pulmonary surfactant (PS) for preventing bronchopulmonary dysplasia (BPD) in premature infants with neonatal respiratory distress syndrome (NRDS). The related studies were retrieved in PubMed, EMBASE, the Cochrane Library, Clinical Trial, CNKI, Wanfang and VIP Database from inception to August 2018. Two reviewers independently screened the studies to ensure that all patients with diagnosis of NRDS were enrolled to studies within 1 day after birth, assessed the quality of included studies by GRADEpro system and extracted the data for review. The meta-analysis was performed by RevMan 5.2 software. A subgroup analysis about inhaled corticosteroid (ICS) delivery method was made between ICS inhalation subgroup [inhalation of ICS by nebulizer or metered dose inhaler (MDI)] and ICS intratracheal instillation subgroup (PS used as a vehicle). Eight randomized controlled trials were enrolled in the meta-analysis, 5 trials of which stated the randomized method, grouping and blinded method, and the follow-up procedures were reported. GRADEpro system showed high quality of 4 trials (5 articles), and the rest 4 trials had moderate quality. Meta-analysis showed that the incidence of BPD was decreased in ICS group, the relative risk (RR) was 0.56 (95% CI: 0.42-0.76), and similar trends were found in ICS inhalation subgroup and ICS intratracheal instillation subgroup, with the corresponding RR being 0.58 (95% CI: 0.41-0.82) and 0.47 (95% CI: 0.24-0.95) respectively. ICS could also significantly reduce the mortality risk as compared with placebo control group (RR: 0.67;95% CI: 0.45-0.99), with RR of ICS inhalation subgroup and ICS intratracheal instillation subgroup being 0.81 (95% CI: 0.34-1.94) and 0.64 (95% CI: 0.41-0.99) respectively. Moreover, the percentage of infants using PS more than one time was lower in ICS group than in the placebo control group, with the RR and 95% CI being 0.55 (95% CI: 0.45-0.67), and that in ICS intratracheal instillation subgroup lower than in ICS inhalation subgroup (RR: 0.56;95% CI: 0.45-0.69, and RR: 0.35;95% CI:0.08-1.52 respectively). There was no significant difference in the incidence of infection or retinopathy of prematurity and neuro-motor system impairment between ICS group and placebo control group, with the corresponding RR being 0.95 (95% CI:0.59-1.52), 0.92 (95% CI: 0.62-1.38) and 1.13 (95% CI: 0.92-1.39), respectively. It was concluded that early administration of ICS and PS is an effective and safe option for preterm infants with NRDS in preventing BPD and reducing mortality, decreasing the additional PS usage, especially for the ICS intratracheal instillation subgroup. Furthermore, the appropriate dose and duration of ICS, combined use of inhalation or instillation of ICS with PS and the long-term safety of airway administration of corticosteroids need to be assessed in large trials.

Surfactant Protein A Polymorphism Is Associated with Susceptibility to Chronic Obstructive Pulmonary Disease (COPD) in Chinese Uighur Population

This study investigatedexamined the correlation between surfactant protein-A (SP-A) polymorphism and the susceptibility of cvhronic obstructive pulmonary disease (COPD) in Xinjiang Uighurs. Genomic DNA was extracted from peripheral blood of 194 COPD smokers and 201 healthy smokers of Uighur who were hospitalized in or paid a visit to one of the four Xingjiang-based hospi-tals involved in the study, betweenfrom March 2009 to December 2010. Single nucleotide polymor-phisms (SNPs) were studied on A/G atwithin amino acid aa62 (CCA/CCG rs1136451) and C/T within aa219 (CGG/TGG, rs4253527) in SP-A. Genotypes were determined by using the TaqMan polymerase chain reaction (PCR). Our results showed that genotype frequencies were different be-tween the COPD and normal smokers infor aa62 (χx2=6.852, P=0.033). There were also significant differences in allele genotype frequencies between the COPD and the control and allele G might de-crease the risk COPD (χx2=6.545, P=0.011; OR=0.663; 95% CI: 0.484–0.909). The result suggested We were led to conclude that polymorphism of aa62 (CCA/CCG, rs1136451) of SP-A may be asso-ciated with the susceptibility to COPD in Xingjiang Uighurs.

Expression of Peroxiredoxins and Pulmonary Surfactant Protein A Induced by Silica in Rat Lung Tissue

Silicosis is one of the most serious occupational diseases in China and dates back to centuries ago. In this study, we successfully established a rat model of silicosis by intratracheal silica injection for 28 days and determined hydroxyproline levels to evaluate collagen metabolism in lung homogenates. Oxidative stress status was evaluated by detecting catalase and glutathione peroxidase activities.

Effect of different ventilation methods combined with pulmonary surfactant on neonatal acute respiratory distress syndrome

BACKGROUND Acute respiratory distress syndrome precipitates is widespread pulmonary injury in impacted individuals,the neonatal respiratory distress syndrome(NRDS),primarily observed in preterm infants,represents a prevalent critical condition in neonatal clinical settings.AIM To investigate the clinical efficacy of various ventilation strategies combined with pulmonary surfactant(PS)therapy in the treatment of NRDS.METHODS A total of 20 neonates diagnosed with respiratory distress syndrome,admitted between May 2021 and June 2022,were randomly assigned to either a research group or a control group.Neonates in the research group received treatment involving high-frequency oscillatory ventilation(HFOV)in conjunction with PS.In contrast,neonates in the control group were administered either controlled mechanical ventilation or synchronous intermittent mandatory ventilation,combined with PS.Arterial blood samples from the neonates in both groups were collected before treatment,as well as 6 h,12 h,24 h,and 48 h post-treatment.These samples underwent blood gas analysis,with measurements taken for pH value,partial pressures of oxygen(O_(2))and carbon dioxide.Concurrently,data was collected on the duration of ventilator use,length of hospitalization time,O_(2) treatment time,treatment outcomes,and complications of the ventilator.RESULTS From 6-48 h post-treatment,both groups demonstrated significant improvements in arterial blood pH and oxygen partial pressure,along with a significant decrease in carbon dioxide partial pressure compared to pre-treatment values(P<0.05).Although these changes progressed over time,there were no significant differences between the two groups(P>0.05).However,the research group had significantly lower X-ray scores,shorter hospitalization time,and less time on O_(2) therapy compared to the control group(P<0.05).Mortality rates were similar between the two groups(P>0.05),but the research group had a significantly lower incidence of complications(P<0.05).CONCLUSION The integration of HFOV combine with PS has proven to effectively expedite the treatment duration,decrease the occurrence of complications,and secure the therapeutic efficacy in managing NRDS.

Functional changes of pulmonary surfactant in rats with lung injury induced by endotoxin

We studied the functional changes of pulmonary surfactant （PS） in acutelung injury models produced by endotoxin injection (E.coli O55B5) in rats.The sur-face properties of the lung lavage liquid and the total phospholipids （TPL） ex-tracted from it were assessed on a modified Wilhelmy film balance.γ-A isothermof the lavage liquid revealed an increase in minimum surface tension and a de-crease in hysteresis area,recruitment index and stability index,whereas that ofTPL extracted from it did not show any change except for hysteresis area.Thesurface activity correlates positively with the TPL content but negatively with thetotal protein content in the lavage liquid.The findings indicated that there was adysfunction of PS in rats with the lung injury induced by endotoxin,suggestingthat the function deficiency of PS might be caused by decreased phospholipidsand increased proteins in the alveoli.

Morphofunctional Characteristics of Pulmonary Surfactant System and Its Effect on Immune Cells in Influenza A (H1N1) Pathogenesis

There is an annual increase of influenza-related SARI cases in winter months. Despite the high relevance of this problem, influenza pathogenesis and the role of surfactant system and its SP-A (surfactant protein A) enzyme in antiviral defense remain poorly understood. SP-A activates macrophage M1 polarization and triggers an antiviral response due to the activation of T-cells and dendritic cells. Therefore, surfactant system is an important element of infection protection and a promising therapeutic target.

Correlation of neonatal pulmonary surfactant protein A gene polymorphism with pneumonia susceptibility and inflammatory response

Objective:To study the correlation of neonatal pulmonary surfactant protein A gene polymorphism with pneumonia susceptibility and inflammatory response.Methods:Neonates who were born and diagnosed with pneumonia in Zigong Maternity and Child Healthcare Hospital between September 2015 and February 2017 were selected as pneumonia group, and neonates without infection were selected as control group. SP-A gene rs1059054 and rs1136454 loci polymorphism, the contents of inflammatory cytokines in serum as well as the expression of inflammatory transcription factors in peripheral blood were determined.Results:The constituent ratio of rs1059054 loci CC genotype of pneumonia group was significantly higher than that of control group while the constituent ratio of CT and TT genotypes were significantly lower than those of control group;the constituent ratio of rs1136454 loci AA genotype was significantly lower than that of control group while the constituent ratio of AG and GG genotypes were significantly higher than those of control group. PCT, sTREM1, TNF-α and IL-6 levels in serum as well as RORγt mRNA expression in peripheral blood of pneumonia children with SP-A gene rs1059054 loci CC genotype were significantly higher than those of pneumonia children with CT genotype and TT genotype while SOCS1 and Foxp3 mRNA expression in peripheral blood were significantly lower than those of pneumonia children with CT genotype and TT genotype;PCT, sTREM1, TNF-α and IL-6 levels in serum as well as RORγt mRNA expression in peripheral blood of pneumonia children with SP-A gene rs1136454 loci AA genotype were significantly lower than those of pneumonia children with AG genotype and GG genotype while SOCS1 and Foxp3 mRNA expression in peripheral blood were significantly higher than those of pneumonia children with AG genotype and GG genotype.Conclusion: Neonatal SP-A gene rs1059054 loci CC genotype can increase the pneumonia susceptibility and aggravate inflammatory response, and rs1136454 loci AA genotype can decrease pneumonia susceptibility and relieve inflammatory response.

Study on Pulmonary Surfactant of Sudden Death of Infant

Objective To find the pathogenesis of sudden infant death syndrome (SIDS) from changes of pulmonary surfactant. Methods By means of thin layer chromatography technique, surfactant in whole lung specimens of 10 infants with SIDS and 10 control infants without SIDS (dead of nonrespiratory diseases) were examined qualitatively and quantitatively. Results Eleven components in pulmonary surfactant were examined qualitatively, including lysophosphatidylcholine, sphingomyelin, phosphatidylcholine, phosphatidylserine, phosphatidylinositol, phosphatidylethanolamine, phosphatidylglycerol, diphosphatidylglycerol, phosphatidic acid, cholesterol and neutral lipids. Quantitative examination showed that the amount of surfactant of whole lung specimens in sudden death group [(8.9±1.0) mg/g wet lung weight] was significantly less than that in control group [(12.6±1.4) mg/g wet lung weight, P<0.01]. Qualitative variance showed that the percentages of phosphatidylcholine (49.4%±2.0%) and phosphatidylglycerol (2.6%±0.7%) decreased markedly in sudden death group compared with those in control group (61.5%±3.0% and 4.3%±1.5%, P<0.01). Conclusion Before death there is serious defect on metabolism of pulmonary surfactant in sudden death infants, with the amount decreasing and the ratio of its components being disturbed, which is one of the important pathogenies of SIDS.

早期联合应用外源性PS和iNO治疗PPHN的效果

目的探讨早期联合应用外源性肺表面活性物质(PS)和吸入一氧化氮(iNO)治疗新生儿持续性肺动脉高压(PPHN)的效果。方法选取2019年1月1日至2021年12月31日收治的100例PPHN患儿为研究对象,按照随机数字表法将其分成对照组和观察组,各50例。对照组应用iNO+安慰剂(空气),观察组应用iNO+外源性PS。比较两组的治疗效果。结果治疗前,两组的肺动脉收缩压(PASP)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、pH及氧合指数(OI)比较,差异无统计学意义(P>0.05);治疗24、48 h后,两组的PASP、PaCO_(2)、OI均降低,PaO_(2)及pH均升高,且观察组优于对照组,差异具有统计学意义(P<0.05)。观察组的治愈率明显高于对照组,应用体外氧合膜肺(ECMO)及死亡率低于对照组,呼吸机使用时间及总住院时间短于对照组,差异具有统计学意义(P<0.05);两组的不良反应发生情况比较,差异无统计学意义(P>0.05)。结论早期联合应用外源性PS和iNO可明显改善PPHN患儿的氧合情况、降低PASP,减少呼吸机使用时间、总住院时间、对ECMO需求及死亡率,值得临床推广应用。

Effects of Different Surfactant Administrations on Cerebral Autoregulation in Preterm Infants with Respiratory Distress Syndrome

To treat respiratory distress syndrome,surfactant is currently delivered via less invasive surfactant administration（LISA） or INtubation SURfactant Extubation（INSURE）.The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation.Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation（Sc O2）,and the mean arterial blood pressure（MABP） was simultaneously recorded.Of 44 preterm infants included,the surfactant was administrated to 22 via LISA and 22 via INSURE.The clinical characteristics,treatments and outcomes of the infants showed no significant differences between the two groups.The correlation coefficient of Sc O2 and MABP（rSc O2-MABP） 5 min before administration was similar in the two groups.During surfactant administration,rSc O2-MABP increased in both groups（0.44±0.10 to 0.54±0.12 in LISA,0.45±0.11 to 0.69±0.09 in INSURE）.In the first and second 5 min after instillation,rSc O2-MABP was not significantly different from baseline in the LISA group,but increased in the first 5 min after instillation（0.59±0.13,P=0.000 compared with the baseline in the same group） and recovered in the second 5 min after instillation（0.48±0.10,P=0.321） in the INSURE group.There were significant differences in the change rates of rSc O2-MABP between the two groups during and after surfactant administration.Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration.The effect duration of LISA is shorter than that of INSURE（〈5 min in LISA vs.5–10 min in INSURE）.

枸橼酸咖啡因辅助PS治疗新生儿呼吸窘迫综合征对血清炎症因子及血气分析的影响分析

目的 分析枸橼酸咖啡因辅助肺表面活性物质(Pulmonary Surfactant,PS)治疗新生儿呼吸窘迫综合征(Neonatal Respiratory Distress Syndrome,NRDS)的临床疗效及对患儿血清炎症因子、肺功能的影响。方法 单纯随机选择2020年1月—2023年1月南通大学附属妇幼保健院儿科收治的80例NRDS患儿为研究对象,按不同治疗方法分为两组,每组40例。对照组采用PS治疗,观察组联合枸橼酸咖啡因辅助治疗,两组均治疗2周。比较两组临床疗效、血清炎性因子、血气指标、治疗效果及并发症发生情况。结果 观察组临床疗效(95.00%)高于对照组,差异有统计学意义(χ^(2)=5.165,P=0.023)。治疗后,观察组C反应蛋白、降钙素原、白细胞计数低于对照组,差异有统计学意义(P均<0.05)。治疗后,观察组pH、动脉血氧分压、氧合指数高于对照组,动脉血二氧化碳分压低于对照组,差异有统计学意义(P均<0.05)。观察组呼吸机使用时间、用氧时间、住院时间均短于对照组,差异有统计学意义(P均<0.05)。观察组呼吸暂停次数少于对照组,差异有统计学意义(P<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论 对NRDS患儿使用枸橼酸咖啡因辅助PS治疗可有效改善患儿血气指标,减轻炎症反应,提高治疗有效率,安全可靠。

Changes of Tumor Necrosis Factor, Surfactant Protein A, and Phospholipids in Bronchoalveolar Lavage Fluid in the Development and Progression of Coal Workers’ Pneumoconiosis

Objective To evaluate the alterations of biomarkers in the development and progression of coal workers＇ pneumoconiosis （CWP）. Methods The type and number of cells, and the levels of tumor necrosis factor-alpha （TNF-α）, pulmonary surfactant protein, phospholipids and fibronectin in bronchoalveolar lavage fluid were assayed in 14 health active coal miners, 21 coal miners without CWP and 13 miners with CWP of 0/1 to 1/1. Results Compared to active coal miners without CWP （8,23μg/mL）, TNF-α concentration was gradually decreased when dust exposure was stopped （5.90 μg/mL）. Elevated surfactant protein A （SP-A） level and phosphatidylglycerol （PG） to phosphatidylinositol （PI） ratio were found in miners actively exposed to coal dust （6528 μg/mL for SP-A and 10. for PG/P1）, and both parameters decreased when CWP progressed from CWP （0/1） （3419μg/mL for SP-A and 5.9 for PG/PI） to CWP （1/1） （1654 μg/mL for SP-A and 5.5 for PG/PI）. Conclusion Biomarkers in bronchoalveolar lavage fluid can be used to screen coal miners at high risk of developing coal workers＇ pneumoconiosis.

Fetal lung surfactant and development alterations in intrahepatic cholestasis of pregnancy

AIM: To investigate the association between total bile acid(TBA) level during intrahepatic cholestasis of pregnancy(ICP) and fetal lung surfactant alteration. METHODS: We recruited 42 ICP and 32 normal pregnancy women in this study. The maternal blood, fetal blood and amniotic fluid TBA level were detected using a circulating enzymatic method. Umbilical blood pulmonary surfactant protein A(SP-A) was evaluated with enzyme-linked immunosorbent assay. High performance liquid chromatography was used for the determination of phosphatidyl choline(PC), phosphatidyl inositol(PI), lysolecithin(LPC) and sphingomyelin(SM). Amniotic fluid lamellar body was counted with a fully automatic blood cell counter. Fetal lung area and fetal body weight were calculated from data obtained with an iu22 color supersonic diagnostic set. Clinical information of a nonstress test, amniotic fluid properties and neonatal Apgar score, and birth weight were recorded for review. RESULTS: The TBA level in maternal blood, fetal blood and amniotic fluid in the ICP group were significantly higher than that in the control group(maternal blood: 34.11 ± 6.75 mmol/L vs 4.55 ± 1.72 mmol/L, P < 0.05; fetal blood: 11.9 ± 2.23 mmol/L vs 3.52 ± 1.56 mmol/L, P < 0.05; amniotic fluid: 3.89 ± 1.99 mmol/L vs 1.43 ± 1.14 mmol/L, P < 0.05). Amniotic fluid PC and PI in the ICP group were significantly lower than that in the control group(PC: 65.71 ± 7.23 μg/m L vs 69.70 ± 6.68 μg/m L, P < 0.05; PI: 3.87 ± 0.65 μg/m L vs 4.28 ± 0.74 μg/m L, P < 0.05). PC/LPC ratio of the ICP group was lower than that of the control group(14.40 ± 3.14 vs 16.90 ± 2.52, P < 0.05). Amniotic LB in the ICP group was significantly lower than that of the control group((74.13 ± 4.37) × 109/L vs(103.0 ± 26.82) × 109/L, P < 0.05). Fetal umbilical blood SP-A level in the ICP group was significantly higher than that of the control group(30.26 ± 7.01 ng/m L vs 22.63 ± 7.42 ng/m L, P < 0.05). Fetal lung area/body weight ratio of the ICP group was significantly lower than that of the control group(5.76 ± 0.63 cm2/kg vs 6.89 ± 0.48 cm2/kg, P < 0.05). In the ICP group, umbilical cord blood TBA concentration was positively correlated to the maternal blood TBA concentration(r = 0.746, P < 0.05) and umbilical blood SP-A(r = 0.422, P < 0.05), but it was negatively correlated to the amniotic fluid lamellar corpuscle(r = 0.810, P < 0.05) and fetal lung area/body weight ratio(r = 0.769, P < 0.05). Furthermore, umbilical blood TBA showed a negative correlation to PC, SM and PI(r pc = 0.536, r sm = 0.438, r pi = 0.387 respectively, P < 0.05). The neonatal asphyxia, neonatal respiratory distress syndrome, fetal distress and perinatal death rates in the ICP group are higher than that of theCONCLUSION: ICP has higher TBA in maternal and fetal blood and amniotic fluid. The high concentration of TBA may affect fetal pulmonary surfactant production and fetal lung maturation.

THE EFFECTS OF RESPIRATORY MODE ON LUNGCOMPLIANCE AND SURFACTANT DURING OPEN HEARTSURGERY IN CHILDREN

Objective To investigate whether lung inflation during cardiopulmonary by -pass (CPB) surgeryfor congenital heart disease is needed to maintain adequate lung mechanics and surfactant phospholipidproduction. Methods Thirty patients (2～10 year) with atrial or ventricular septal defects were randomly dividedinto 3 groups. group I (control group). IPPV; group Ⅱ： PEEP= 0.392kpa; group Ⅲ: IPPV and lungs inflated with0.392kPa during CPB. Results Crs was measured and airway aspirates were obtained. At the end of surgery,compared with the other 2 groups Crs, SatPC/TP and SatPC/TPL was decreased significantly in group I andlower than its baseline (P<0.05). Conclusio Use of PEEP and lung inflation during open heart surgery inchildren was more effective to improve lung function and surfactant phospholipid production.

两种不同技术PS给药对NRDS并呼吸困难早产儿肺功能及不良反应的影响

目的:对比不同技术肺表面活性物质(PS)给药联合咖啡因对新生儿呼吸窘迫综合征(NRDS)早产儿肺功能及不良反应的影响。方法:选取2019年8月-2023年8月本院收治的NRDS早产儿,随机数字表以简单随机法分为对照组(n=52)与观察组(n=53),对照组予以气管插管-使用肺表面活性物质-拔管技术(INSURE)PS给药联合咖啡因治疗,观察组采用微创肺表面活性物质给药技术(LISA)PS给药联合咖啡因治疗。比较两组治疗后24 h的疗效,患儿达到纠正年龄36周时的肺功能指标[潮气量(VT)、呼吸频率(RR)、分钟通气量(MV)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、25%、50%及75%潮气量时的呼气流速(FEF25%、FEF50%、FEF75%)]、治疗前与治疗后24h的呼吸力学指标[气道阻力、静态肺顺应性、内源性呼气末正压(PEEP)]、血气分析值[氧分压(PaO_(2))值、二氧化碳分压(PaCO_(2))值、pH]、患儿接受治疗的各项时间指标(呼吸困难消失时间、无创辅助通气总时间、住院时间)、用药期间不良反应及住院期间发症发生率。结果:治疗24h后,观察组疗效(94.3%)高于对照组(88.8%),患儿达到纠正年龄36周时RR、气道阻力与内源性PEEP低于对照组,MV、TPTEF/TE、VPEF/VE、FEF25%、FEF50%、FEF75%、静态肺顺应性均高于对照组,两组血气分析值部分指标均较治疗前有明显恢复,且观察组PaO_(2)与pH高于对照组,PaCO_(2)低于对照组(均P<0.05)。观察组住院时间(18.63±1.83d)少于对照组(20.57±2.07d)(均P<0.05)。各项不良反应及并发症的发生率两组无差别(P>0.05)。结论:INSURE技术与LISA技术PS给药联合咖啡因对NRDS早产儿均有一定疗效,但LISA技术疗效更好,对早产儿肺功能、呼吸功能及血气值均有良好影响,并能促进患儿康复,用药及住院期间未增加早产儿不良反应及并发症发生。

Establishment of Surfactant-associated Protein A Suicide Gene System and Analysis of Its Activity

Summary： Alveolar epithelial type II （AT II） cells are essential for lung development and remodeling, as they are precursors for type I cells and also produce other non-repair cells （fibroblasts）. Progenitor ceils are believed to possess capability of multi-potent transdifferentiation, which is closely related to the niche, suggesting the importance of establishment of a lung progenitor cell niche model. We hypothesized that pulmonary surfactant-associated protein A （SPA） suicide gene system would cause AT II cell to kill itself through apoptosis and leave its niche. In vitro, the recombinant adeno-associated virus vectors-SPA-thymidine kinase （rAAV-SPA-TK） system was established to get targeted apoptotic AT II cells. The apoptosis of AT II cells was detected by using MTT. The results showed that cloned SPA gene promoter had specific transcriptional activity in SPA high expression cells, and SPA high expression cells （H441） transfected with TK gene had higher sensitivity to ganciclovir （GCV） than SPA low expression cells （A549）. In vivo, increased apoptosis of AT II cells induced by GCV in rAAV-SPA-TK system was observed by TUNEL. Finally, the successful packaging and application of rAAV-SPA-TK system provide experimental basis to get specific lung progenitor cell （AT II） niche in vitro and in vivo.

枸橼酸咖啡因注射液联合CPS对NRDS患儿肺功能的影响

目的研究枸橼酸咖啡因注射液联合注射用牛肺表面活性剂(CPS)对新生儿呼吸窘迫综合征(NRDS)患儿潮气呼吸肺功能及血清氧化应激指标的影响。方法选取74例NRDS患儿,根据治疗方案分为对照组(采用CPS)和观察组(采用枸橼酸咖啡因注射液联合CPS治疗)。比较两组临床疗效、治疗前后血气分析指标、潮气呼吸肺功能指标、血清氧化应激指标及E-选择素(CD62E)水平及并发症发生率。结果观察组临床总有效率高于对照组,差异具有统计学意义(P<0.05);治疗7 d后,观察组PaO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05);治疗7 d后,观察组达峰时间比(TPTEF/TE)、潮气量(VT)、达峰容积比(VPEF/VE)均大于对照组,呼吸频率(RR)低于对照组(P<0.05);与对照组相比,观察组治疗7 d后,血清谷胱甘肽过氧化物酶(GSH-Px)、总抗氧化能力(T-AOC)的水平较高,而E-选择素(CD62E)、丙二醛(MDA)的水平较低(P<0.05);两组并发症总发生率相比,差异无统计学意义(P>0.05)。结论采用枸橼酸咖啡因联合CPS治疗可有效促进NRDS患儿血气分析指标、肺功能改善,缓解氧化应激炎症状态,安全性良好。

表面活性剂对PS包覆微米Al粉性能的影响

采用不同表面活性剂对微米Al粉进行表面预处理,运用分散聚合方法使苯乙烯(St)在Al粉表面聚合,获得了铝粉-聚苯乙烯(Al-PS)复合粒子;研究了表面活性剂类型对Al粉及Al-PS复合粒子亲水亲油性能、分散性能的影响;通过UV-VIS、FTIR光谱分别对PS对Al粉包覆量及Al-PS复合粒子结构进行了测试和表征。结果表明:采用十二烷基磺酸钠(SDS)对Al粉预处理后,Al粉的性能最佳;聚合过程中采用十二烷基苯磺酸钠(DBSB),复合粒子的性能最好。