丙氨酰谷氨酰胺、肺表面活性物质联合无创辅助通气治疗新生儿急性肺损伤/急性呼吸窘迫综合征的临床效果  

Clinical effects of alanyl glutamine and pulmonary surfactant combined with adjuvant noninvasive ventilation therapy on neonatal acute lung injury/acute respiratory distress syndrome

作　　者：李敬娴 何金孝 乔红玉 罗建峰 LI Jing-xian;HE Jin-xiao;QIAO Hong-yu;LUO Jian-feng(Department of Pediatrics,the First Affiliated Hospital of the People′s Liberation Army Air Force Medical University,Xi′an 710032,China)

机构地区：[1]中国人民解放军空军军医大学第一附属医院儿科,陕西省西安市710032

出　　处：《广西医学》2022年第1期1-5,共5页Guangxi Medical Journal

基　　金：国家自然科学基金(81700314)。

摘　　要：目的探讨丙氨酰谷氨酰胺、肺表面活性物质联合无创辅助通气治疗新生儿急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)的效果。方法将60例ALI/ARDS患儿分为观察组和对照组,各30例。两组均给予持续气道正压通气联合气管内滴注猪肺磷脂注射液治疗,观察组同时给予静脉补充丙氨酰谷氨酰胺治疗。比较两组患儿的28 d存活率、无创辅助通气时间、用氧治疗时间及住院天数,以及治疗前后动脉血气分析、氧化应激及免疫功能指标。记录两组患儿治疗期间的不良反应发生情况。结果治疗后,两组患儿28 d存活率差异无统计学意义(P>0.05),但观察组患儿的无创辅助通气时间、用氧治疗时间及住院时间均短于对照组(均P<0.05);两组的动脉血气分析指标、氧化应激指标均较治疗前改善,且观察组的指标均优于对照组(均P<0.05);观察组的CD4+T淋巴细胞、CD8^(+)T淋巴细胞水平及两者比例均优于治疗前和对照组(均P<0.05),但对照组治疗前后的细胞免疫功能指标差异无统计学意义(均P>0.05)。两组患儿的不良反应发生率差异无统计学意义(P>0.05)。结论在肺表面活性物质联合无创辅助通气治疗的基础上给予静脉补充丙氨酰谷氨酰胺,可更好地改善ALI/ARDS新生儿的肺通气和氧合功能,进而缩短辅助通气和氧疗时间,其机制可能与抑制机体氧化应激水平、提高机体免疫功能有关。Objective To investigate the efficacy of alanyl glutamine and pulmonary surfactant combined with adjuvant noninvasive ventilation for the treatment of neonatal acute lung injury/acute respiratory distress syndrome(ALI/ARDS).Methods Sixty neonates with ALI/ARDS were divided into observation group(n=30)and control group(n=30).Both groups were given continuous positive airway pressure combined with intratracheal drip of Poractant Alfa Injection,and the observation group was intravenously given alanyl glutamine supplements additionally.The 28-day survival rate,duration of adjuvant noninvasive ventilation,duration of oxygen treatment,and length of hospital stay,as well as pre-and post-treatment arterial blood gas analysis indices,oxidative stress indicators,and immune function indicators,were compared between the two groups.The incidence of adverse reactions during the treatment was recorded in the two groups.Results After the treatment,there was no statistically significant difference in the 28-day survival rate between the two groups(P>0.05),whereas the observation group exhibited decreases in duration of adjuvant noninvasive ventilation,duration of oxygen treatment,and length of hospital stay than the control group(all P<0.05);the indices of arterial blood gas analysis and the indicators of oxidative stress were improved in both groups as compared with those before the treatment,and the observation group yielded superior indices than the control group(all P<0.05);the levels of CD4+T lymphocytes and CD8^(+)T lymphocytes as well as their ratio in the observation group were superior than those before the treatment or in the control group(all P<0.05),but the indicators of cellular immune function before and after the treatment showed no statistically significant difference in the control group(all P>0.05).No statistically significant difference was found in the incidence rate of adverse reactions between the two groups(P>0.05).Conclusion Intravenous administration of alanyl glutamine based on pulmonary surfactant combi

关 键 词：急性肺损伤 急性呼吸窘迫综合征 新生儿 肺表面活性物质 丙氨酰谷氨酰胺 无创辅助通气 

分 类 号：R725.63[医药卫生—儿科]