高频振荡通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的研究

Effect of high frequency oscillatory ventilation combined with lung surfactant on neonatal respiratory distress syndrome

摘要:

目的 探讨高频振荡通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的疗效，以及对炎症因子、心肌损伤标志物、microRNA-21（miR-21）、呼吸力学指标、肺功能指标的影响。方法 选取南通市妇幼保健院2018年1月—2020年12月收治的新生儿呼吸窘迫综合征患儿150例，按照治疗方法分为对照组与干预组，每组75例。对照组实施常规通气联合肺表面活性物质治疗，干预组实施高频振荡通气联合肺表面活性物质治疗。采用放射免疫测定肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平；采用酶联免疫吸附试验（ELISA）检测肌酸磷酸激酶同工酶（CK-MB）、氨基末端B型脑钠肽前体（NT-proBNP）水平；采用实时荧光定量聚合酶链反应（qRT-PCR）检测miR-21 mRNA相对表达量；检测并比较两组的呼吸力学指标、肺功能指标，比较两组的临床疗效和并发症总发生率。结果 干预组治疗后7 d的TNF-α、IL-6、IL-8、CK-MB、NT-proBNP水平、miR-21 mRNA相对表达量、PaCO₂低于对照组（P <0.05）；干预组PaO₂、氧合指数、每千克体重潮气量（TV）、达峰容积比（TPEF/TE）、达峰时间比（VPEF/VE）高于对照组（P <0.05）；两组治疗有效率比较，差异无统计学意义（P >0.05）；干预组并发症总发生率（5.33%）低于对照组（16.00%）（P <0.05）。结论 高频振荡通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征疗效显著，改善患儿呼吸功能和肺功能，减轻炎症反应，保护心肌细胞，减少并发症。

Abstract:

Objective To explore the efficacy of high-frequency concussion ventilation combined with lung surfactant in neonatal respiratory distress syndrome and the effects on inflammatory factors, myocardial injury markers, microRNA-21 (miR-21), respiratory mechanics indicators, and lung function indicators.Methods A total of 150 children with neonatal respiratory distress syndrome admitted from January 2018 to December 2020 were selected into control and intervention groups according to the randomized number table, with 75 cases in each group. The control group performed conventional ventilation with pulmonary surfactant and the intervention group performed high frequency concussion ventilation with pulmonary surfactant. The levels of tumor necrosis factor- α(TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) were determined by radioimmunoassay; The levels of the creatine phosphokinase MB isoenzyme (CK-MB) and the amino-terminal type B brain sodium peptide precursor (NT-proBNP) were measured by an ase-linked immunosorbent assay (ELISA); The relative expression amount of miR-21 mRNA was measured by quantitative real-time polymerase chain reaction (qRT-PCR); The respiratory mechanics indexes and lung function indexes were compared between the two groups; The clinical efficacy and the overall incidence of complications were compared between the two groups.Results The levels of TNF-α, IL-6, IL-8, CK-MB, NT-proBNP, relative expression of miR-21 mRNA and PaCO₂ in intervention group were lower than those in control group 7 days after treatment (P < 0.05). PAO₂, Oxygenation Index, TV, TPEF/Te, VPEF/VE in intervention group were higher than those in control group (P < 0.05). There was no significant difference between the two groups (P > 0.05); total complication rate of intervention group (5.33%) lower than the control group (16. 00%) (P < 0.05).Conclusions High-frequency concussion ventilation combined with pulmonary surfactant is effective in the treatment of neonatal respiratory distress syndrome, improving respiratory function and lung function in children, reducing inflammatory response, protecting cardiomyocytes, and reducing complications.