无创高频振荡通气对急性呼吸衰竭新生儿SP-D、AQP-5水平的影响  

Effect of noninvasive high frequency oscillatory ventilation combined with PS on the level of SP-D and AQP-5 in neonatal acute respiratory failure

作　　者：原静[1] YUAN Jing(Department of Neonatology,the First Hospital of Handan,Handan,Hebei 056002,China)

机构地区：[1]邯郸市第一医院新生儿科,河北邯郸056002

出　　处：《临床肺科杂志》2018年第10期1794-1799,共6页Journal of Clinical Pulmonary Medicine

基　　金：河北省2017年度医学科学研究重点课题(No 20171111)

摘　　要：目的探讨无创高频振荡通气治疗新生儿急性呼吸衰竭患者对其SP-D(肺表面活性物质D,Pulmonary surfactant D)、AQP-5(肺组织水通道蛋白5,Lung tissue water channel protein 5)水平的影响。方法选择2014年1月-2017年1月在本院诊治的急性呼吸衰竭患儿(acute respiratory failure,ARF)94例,按随机数字法分为无创高频(noninvasive high-frequency ventilation,NHFOV)组和常频机械通气(Constant frequency mechanical ventilation,CMV)组。NHFOV组予NHFOV治疗,CMV组给予CMV治疗,然后观察两组的治疗效果及机械通气时间、用氧时间、住院时间、并发症等,在治疗前、治疗12、24、48、72h监测两组患者的呼吸动力学、血气指标以及血清SP-D、AQP-5水平。结果NHFOV组的有效率为93.61%,显著高于CMV组(78.32%),差异有统计学意义(P=0.037);NHFOV组的气漏、呼吸相关性肺炎、下呼吸道感染等并发症显著低于CMV组,差异有统计学意义(P<0.05);NHFOV组的机械通气时间、用氧时间、经口喂养时间、住院时间显著短于CMV组(P<0.05);两组患儿的Pa O_2、Pa CO_2、Pa O_2/Fi O_2、OI、RI、p H在治疗后均较治疗前显著改善,差异有统计学意义(P<0.05),NHFOV组的血气指标、呼吸动力学在各时间点均明显改善,均显著优于CMV组,差异有统计学意义(P<0.05);在治疗后两组患者的SP-D、AQP-5水平均较治疗前改善显著(P<0.05),在治疗24h内两组患者的SP-D、AQP-5水平差异不大,差异无统计学意义(P>0.05),24h后各时间点NHFOV组的血清SP-D、AQP-5水平显著低于CMV组,差异有统计学意义(P<0.05);结论 NHFOV治疗新生儿ARF疗效较好,可以有效改善氧合功能,并且不良反应较少,在临床上应用价值较高。Objective To investigate the effect of noninvasive high-frequency ventilation on the level of SPD（ pulmonary surfactant D） and AQP-5（ lung tissue water channel protein 5） in treatment of neonatal acute respiratory failure.Methods 94 children with acute respiratory failure（ ARF） from January 2014 to January 2017 were selected and randomly divided into the noninvasive high-frequency ventilation（ NHFOV） group and the constant frequency mechanical ventilation（ CMV） group.The NHFOV group was treated with NHFOV,and the CMV group was treated with CMV.Their treatment effect and mechanical ventilation time,oxygen time,hospital stay,and complications were observed.Before and 12,24,48 and 72 h after treatment,their respiratory dynamics,blood gas index and serum SP-D and AQP-5 levels were recorded.Results The effective rate of the NHFOV group was 93.61%,which was significantly higher than that of the CMV group（78.32%）（ P = 0.037）.The complications of gas leakage,respiratory associated pneumonia and lower respiratory tract infection in the NHFOV group were significantly lower than those in the CMV group（ P〈0.05）.The time of mechanical ventilation,oxygen time,feeding time and hospital stay in the NHFOV group were significantly shorter than those in the CMV group（ P〈0.05）.The value of Pa O_2,Pa CO_2,Pa O_2/Fi O_2,OI,RI and p H in the two groups were significantly improved after treatment,and the difference was statistically significant（ P〈0.05）.The blood gas index and respiratory dynamics in the NHFOV group were significantly better than those in the CMV group at all time points,and the difference was statistically significant（ P〈0.05）.There was no significant difference in the level of SP-D and AQP-5 between the two groups 24 h after treatment（ P〉0.05）.The serum level of SP-D and AQP-5 in the NHFOV group after 24 h was significantly lower than that in the CMV group（ P〈0.05）.Conclusion The effect of NHFOV in treatment of newborn ARF is better.It can improve oxygena

关 键 词：无创高频振荡通气 PS(肺表面活性物质) 新生儿急性呼吸衰竭 AQP-5(肺组织水通道蛋白5) SP-D(肺表面活性物质D) 

分 类 号：R722.1[医药卫生—儿科]