PS联合BiPAP治疗NRDS临床疗效及对新生儿肺氧合功能 肺泡灌洗液Bcl-2 Caspase-3和TGF-β1水平的影响  

Clinical efficacy of PS combined with BiPAP in the treatment of NRDS and its effect on pulmonary oxygenation function,expressions of Bcl-2,Caspase-3 and TGF-β1 in bronchoalveolar lavage fluid

作　　者：高凌云[1] 王战胜[1] 段道云 Gao Lingyun;Wang Zhansheng;Duan Daoyun(Shangqiu First People's Hospital,Shangqiu 476100,Henan,China)

机构地区：[1]商丘市第一人民医院,河南商丘476100

出　　处：《临床心身疾病杂志》2022年第6期14-20,共7页Journal of Clinical Psychosomatic Diseases

基　　金：商丘市科技攻关计划项目(编号2017011562)。

摘　　要：目的 探讨肺表面活性物质联合双水平持续气道正压通气治疗新生儿呼吸窘迫综合征的临床效果及对新生儿肺氧合功能、肺泡灌洗液Bcl-2、半胱氨酸蛋白酶-3和转化生长因子-β1水平的影响。方法 将142例新生儿呼吸窘迫综合征患儿按治疗方法不同分为两组,观察组(66例)采用肺表面活性物质联合双水平持续气道正压通气治疗,对照组(76例)采用肺表面活性物质联合持续气道正压通气治疗。比较两组一般治疗指标、肺氧合功能及肺泡灌洗液Bcl-2、半胱氨酸蛋白酶-3、转化生长因子-β1水平,并统计两组并发症及预后转归状况。结果 观察组上机时间、氧疗时间、总住院时间均显著短于对照组(P<0.05或0.01),总住院费用显著少于对照组(P<0.01),治疗成功率显著高于对照组(P<0.05),两组有创通气、外源性肺表面活性物质时龄、二次应用外源性肺表面活性物质占比比较差异无统计学意义(P>0.05)。治疗后各时点两组动脉血氧分压/吸入氧浓度均较治疗前显著升高(P<0.05),氧合指数、呼吸指数均较治疗前显著下降(P<0.05),观察组治疗后各时点动脉血氧分压/吸入氧浓度显著高于对照组(P<0.05),氧合指数、呼吸指数显著低于对照组(P<0.05)。治疗后观察组肺泡灌洗液Bcl-2水平显著高于对照组(P<0.01),半胱氨酸蛋白酶3和转化生长因子-β1水平显著低于对照组(P<0.01)。治疗后观察组鼻损失、腹胀发生率显著低于对照组(P<0.05),两组气漏、支气管肺发育不良、颅内出血、肺出血、通气失败及死亡发生率比较差异均无统计学意义(P>0.05)。结论 在应用肺表面活性物质治疗基础上无论是应用持续气道正压或双水平持续正压通气治疗新生儿呼吸窘迫综合征均可取得满意效果,但双水平持续正压通气对患儿肺氧合功能的改善作用、肺泡细胞凋亡的抑制作用、机体炎症反应的缓解作用均更为显著,并能在�Objective To investigate the clinical efficacy of pulmonary surfactant(PS) combined with bi-level positive airway pressure(BiPAP) in the treatment of neonatal respiratory distress syndrome(NRDS) and its effect on pulmonary oxygenation function, expressions of Bcl-2, Caspase-3 and transforming growth factor-β1(TGF-β1) in bronchoalveolar lavage fluid(BALF). Methods A total of 142 children with NRDS were divided into two groups according to different treatment methods. The observation group(66 cases) was treated with PS combined with BiPAP, and the control group(76 cases) was treated with PS combined with continuous positive airway pressure(CPAP). The general treatment indicators, pulmonary oxygenation function and expressions of Bcl-2, Caspase-3 and TGF-β1 in BALF were compared between the two groups.The complications and prognosis of the two groups were analyzed.Results The ventilation beginning time,oxygen therapy time and total hospital stay in the observation group were significantly shorter than those in the control group(P<0.05 or 0.01).The total hospitalization cost was significantly lower than that of the control group(P<0.01),and the success rate of treatment was significantly higher than that of the control group(P<0.05).There was no significant difference in invasive ventilation,the age of PS and the proportion of secondary PS application between the two groups(P>0.05).After treatment,arterial partial pressure of oxygen/fraction of inspired oxygen(PaO/FiO)in the two groups at each time point was significantly higher than that before treatment(P<0.05).Oxygenation index(OI)and respiratory index(RI)were significantly decreased compared with those before treatment(P<0.05).PaO/FiOin the observation group was significantly higher than that in the control group at each time point after treatment(P<0.05),and OI and RI were significantly lower than those in the control group(P<0.05).After treatment,Bcl-2 in BALF of the observation group was significantly higher than that of the control group(P<0.01),while Casp

关 键 词：新生儿 呼吸窘迫综合征 肺表面活性物质 双水平持续气道正压通气 肺氧合功能 肺泡灌洗液Bcl-2 半胱氨酸蛋白酶-3 转化生长因子-β1 

分 类 号：R722.1[医药卫生—儿科]