外源性肺泡表面活性物质对胎粪吸入综合征患儿肺功能及血管内皮生长因子的影响  

Effects of pulmonary surfactant treatment on pulmonary function and levels of vascular endothelial growth fac tor in the newborns with MAS

作　　者：夏耀方[1] 刘翠青[1] 

机构地区：[1]河北省儿童医院新生儿科,石家庄050031

出　　处：《中国实用儿科杂志》2013年第1期31-34,共4页Chinese Journal of Practical Pediatrics

基　　金：河北省医学科研重点课题(08032)

摘　　要：目的观察外源性肺表面活性物质(PS)治疗胎粪吸入综合征(MAS)对患儿肺功能及血清中血管内皮生长因子(VEGF)的影响以及并发症的发生情况。方法将2008年2月至2010年1月在河北省儿童医院新生儿科住院的41例重症MAS病例随机分成两组,22例为应用PS治疗组(PS组),在机械通气及常规治疗的同时应用国产牛肺表面活性剂70mg/kg治疗;19例为常规治疗组(对照组),给予机械通气及常规治疗,分别在0、24、72h和7d监测两组患儿血中VEGF的含量;并观察患儿肺功能改善、上机时间、氧暴露时间和并发症的发生情况。结果两组患儿胎龄、体重、日龄、性别、生产方式相比差异无统计学意义(P>0.05)。两组患儿在0hMAP、Cydn、Raw差异无统计学意义,24h与0h相比MAP与Raw降低,Cydn升高,差异有统计学意义(P<0.05),至72hMAP与Raw继续降低,Cydn继续升高,这种趋势更加明显。24hPS组与对照组的MAP、Raw均低于对照组、Cydn高于对照组,两组之间差异有统计学意义(P<0.05),至72hPS组与对照组的MAP、Raw仍低于对照组、Cydn仍高于对照组。VEGF含量:PS组与C组相比,0h两组之间差异无统计学意义(P>0.05);24h、72hPS组VEGF水平逐渐升高,但均低于C组,两组之间差异无统计学意义(P>0.05);7d两组差异无统计学意义。PS组机械通气时间、氧暴露时间及住院天数均低于对照组,两组间差异有统计学意义(P<0.05)。PS组较对照组气漏、败血症,呼吸机相关性肺炎的发生率明显减低,差异有统计学意义(P<0.05),两组间死亡率的发生率差异无统计学意义(P>0.05)。结论外源性PS治疗MAS时能抑制炎症反应、减轻肺损伤,有可能通过调节VEGF的水平,改善血管内皮的通透性,从而提高肺顺应性,降低肺阻力,改善肺功能,减少气漏和败血症的发生率。Objective To evaluate effects of pulmonary surfactant （PS） treatment for MAS on pulmonary function and levels of vascular endothelial growth factor （VEGF）. Methods Totally 41 newborns, who were enrolled in the intensive care unit in Hebei Province Children Hospital from February 2008 to January 2010 requiring mechanical ventilation for MAS, were assigned randomly into treatment group （PS group）and conventional mechanical ventilation treatment group （control group ） . MAP, Cydn and Raw were recorded, levels of VEGF were detected from venous blood at 0 h, 24 h, 72 h and 7 d after therapy. Results There were no significant differences in gestational age, birth weight or age at ad- mission hours between two groups （P 〉 0.05）. At the beginning of the treatment , no significant differences were detect- ed in MAP, Cydn and Raw between two groups. After 24h, MAP and Raw decreased significantly（P 〈 0.05）, but Cydn increased.This tendency was more obvious till 72h. There was no significant difference in levels of VEGF between two groups in 0 h （P 〉 0.05）. In 24 h and 72 h VEGF levels were elevated; PS group was lower than those of control group ; the difference between two groups was significant （P 〈 0.05）. There were no significant differences between two groups till the 7th day.Duration of mechanical ventilation and oxygen exposure time were significantly lower than the control group , the difference being statistically significant （P 〈 0.05）. The incidence rate of pneumothorax, septicemia and VAP （ventilator associated pneumonia） in PS group was lower than control group. There were no significant differences in the mortality between two groups （P 〉 0.05 ）. Conclusion Application of exogenous pulmonary surfac- rant in treatment of meconium aspiration syndrome could improve pulmonary function, shorten ventilation time, down regulate VEGF level and decrease the incidence rate of pneumothorax and septicemia.

关 键 词：肺表面活性物质 胎粪吸入综合征 血管内皮生长因子 新生儿 

分 类 号：R72[医药卫生—儿科]