[1]徐　超,靳　莉,张　华.体外膜肺氧合联合丙种球蛋白治疗儿童重症腺病毒肺炎合并呼吸衰竭疗效观察[J].新乡医学院学报,2022,39(9):859-864.[doi:10.7683/xxyxyxb.2022.09.013]
　XU Chao,JIN Li,ZHANG Hua.Efficacy of extracorporeal membrane oxygenation combined with gamma globulin in the treatment of children with severe adenovirus pneumonia and respiratory failure[J].Journal of Xinxiang Medical University,2022,39(9):859-864.[doi:10.7683/xxyxyxb.2022.09.013]
点击复制

体外膜肺氧合联合丙种球蛋白治疗儿童重症腺病毒肺炎合并呼吸衰竭疗效观察
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年9
页码:
859-864
栏目:
临床研究
出版日期:
2022-09-05

文章信息/Info

Title:
Efficacy of extracorporeal membrane oxygenation combined with gamma globulin in the treatment of children with severe adenovirus pneumonia and respiratory failure
作者:
徐　超; 靳　莉; 张　华
（郑州大学附属郑州中心医院呼吸与危重症医学科，河南　郑州　450000）
Author(s):
XU Chao; JIN Li; ZHANG Hua
（Department of Respiratory and Critical Care Medicine,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou 450000,Henan Province,China)
关键词:
重症腺病毒肺炎; 呼吸衰竭; 体外膜肺氧合; 丙种球蛋白; 巨噬细胞炎症蛋白-1α; 干扰素-γ
Keywords:
severe adenovirus pneumonia; respiratory failure; extracorporeal membrane oxygenation; gamma globulin; macrophage inflammatory protein-1α; interferon-γ
分类号:
R725.6
DOI:
10.7683/xxyxyxb.2022.09.013
文献标志码:
A
摘要:
目的　探讨体外膜肺氧合（ECMO）联合丙种球蛋白治疗儿童重症腺病毒肺炎合并呼吸衰竭的临床疗效及对患儿呼吸功能、炎症反应和免疫指标的影响。方法　选择2019年2月至2021年7月郑州大学附属郑州中心医院收治的重症腺病毒肺炎合并呼吸衰竭患儿92例为研究对象。对照组患儿给予甲硝唑、柴桂退热口服液、止咳平喘糖浆，同时给予鼻导管吸气，病情严重者酌情给予呼吸机辅助通气，连续治疗3～5 d。观察组患儿在对照组治疗基础上静脉滴注丙种球蛋白50 mL，每日1次，连续治疗3～5 d；同时应用Bio-Medicus灌注系统、Bio-Console 560离心泵系统、Bio-Pump离心泵给予ECMO，当ECMO循环流量为患儿血流量10%～25%且能维持正常代谢，胸部影像学显示肺部病变吸收良好，肺顺应性改善，血气分析正常，血流动力学稳定时，可考虑停止ECMO。记录并比较2组患儿住院时间、持续发热时间、呼吸机使用时间。治疗后评估2组患儿的临床疗效，并计算总有效率。分别于治疗前后抽取2组患儿清晨空腹外周动脉血2 mL，应用全自动血气分析仪测定氧合指数（OI）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）。分别于治疗前后应用肺功能测试仪测定2组患者气道阻力。分别于治疗前后抽取2组患儿清晨空腹外周静脉血2 mL，离心，取上清液，使用流式细胞仪测定血清CD3﹢、CD4﹢、CD8﹢水平，并计算CD4﹢与CD8﹢水平比值（CD4﹢/CD8﹢）；采用酶联免疫吸附法测定血清中巨噬细胞炎症蛋白-1α（MIP-1α）、肿瘤坏死因子-α（TNF-α）、干扰素-γ（IFN-γ）水平。记录2组患儿治疗期间局部疼痛、胃肠不适、感染等不良反应发生情况。结果　观察组患儿住院时间、持续发热时间及呼吸机使用时间均显著短于对照组（P<0.05）。治疗后，对照组和观察组患儿治疗总有效率分别为67.39%（31/46）、89.13%（41/46），观察组患儿治疗总有效率显著高于对照组患儿（χ2=6.389，P<0.05）。2组患儿治疗后的OI、气道阻力、PaCO2均显著低于治疗前，PaO2显著高于治疗前（P<0.05）；治疗后，观察组患儿的OI、气道阻力、PaCO2均显著低于对照组，PaO2显著高于对照组（P<0.05）。2组患儿治疗后的CD3﹢、CD4﹢水平及CD4﹢/CD8﹢均显著高于治疗前（P<0.05）；治疗后，观察组患儿的CD3﹢、CD4﹢水平及CD4﹢/CD8﹢均显著高于对照组（P<0.05）。2组患儿治疗后血清中TNF-α、IFN-γ、MIP-1α水平显著低于治疗前（P<0.05）；治疗后，观察组患儿血清中TNF-α、IFN-γ、MIP-1α水平显著低于对照组（P<0.05）。治疗期间，对照组患儿出现胃肠不适2例，感染2例，不良反应发生率为8.70%（4/46）；观察组患儿出现局部疼痛2例，不良反应发生率为4.35%（2/46）。2组患儿的不良反应发生率比较差异无统计学意义（χ2=0.178，P>0.05）。结论　在常规治疗基础上应用ECMO联合丙种球蛋白治疗儿童重症腺病毒肺炎合并呼吸衰竭的临床疗效显著，有助于改善呼吸相关指标，减轻炎症反应，增强机体免疫力，且安全性较高。
Abstract:
Objective　To investigate the clinical effect of extracorporeal membrane oxygenation (ECMO) combined with gamma globulin in the treatment of children with severe adenovirus pneumonia and respiratory failure and its effect on respiratory function,inflammatory response and immune indexes of children.Methods　A total of 92 children with severe adenovirus pneumonia and respiratory failure who were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 2019 to July 2021 were selected as the research subjects.The children in the control group were given metronidazole,Chaigui Ture Oral Liquid,Zhike Pingchuan Syrup,and nasal cannula for inhalation at the same time;those with severe illness were given ventilator-assisted ventilation as appropriate;continuous treatment for 3-5 days.On the basis of the treatment of the control group,the children in the observation group were given gamma globulin 50 mL by intravenous drip,once a day for 3-5 days;at the same time,the Bio-Medicus perfusion system,Bio-Console 560 centrifugal pump system,and Bio-Pump centrifugal pump were used to give ECMO.When the ECMO circulation flow was 10%-25% of the blood flow of the children and could maintain normal metabolism,and chest imaging showed that the pulmonary lesions were well absorbed,and the lung compliance was improved,and the blood gas analysis was normal,and the hemodynamics was stable,ECMO could be considered to be discontinued.The hospitalization time,continuous fever time and ventilator use time of children were recorded and compared between the two groups.After treatment,the clinical efficacy of children in the two groups was evaluated,and the total effective rate was calculated.Before and after treatment,2 mL of fasting peripheral arterial blood was drawn from children in the two groups in the morning,and the oxygenation index (OI),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) were measured by automatic blood gas analyzer.The airway resistance of patients in the two groups was measured by pulmonary function tester before and after treatment.Before and after treatment,2 mL of fasting peripheral venous blood was drawn from the children in the two groups in the morning,then was centrifuged,and the supernatant was collected;the serum levels of CD3﹢,CD4﹢ and CD8﹢ were measured by flow cytometry,and the ratio of CD4﹢ to CD8﹢ levels (CD4﹢/CD8﹢) was calculated;the levels of macrophage inflammatory protein-1α (MIP-1α)，tumor necrosis factor-α (TNF-α),interferon-γ (IFN-γ) in serum were measured by enzyme-linked immunosorbent assay.The occurrence of local pain,gastrointestinal discomfort,infection and other adverse reactions of children in the two groups were recorded during treatment.Results　The hospitalization time,continuous fever time and ventilator using time of children in the observation group were significantly shorter than those in the control group (P<0.05).After treatment,the total effective rate of children in the control group and observation group was 67.39% (31/46) and 89.13% (41/46),respectively;the total effective rate of children in the observation group was significantly higher than that in the control group (χ2=6.389,P<0.05).The OI,airway resistance and PaCO2 of children in the two groups after treatment were significantly lower than those before treatment,and the PaO2 was significantly higher than that before treatment (P<0.05);after treatment,the OI,airway resistance and PaCO2 of children in the observation group were significantly lower than those in the control group,and the PaO2 was significantly higher than that in the control group (P<0.05).The levels of CD3﹢,CD4﹢ and CD4﹢/CD8﹢ of children in the two groups after treatment were significantly higher than those before treatment (P<0.05);after treatment,the levels of CD3﹢,CD4﹢ and CD4﹢/CD8﹢ of children in the observation group were significantly higher than those in the control group (P<0.05).The serum levels of TNF-α,IFN-γ and MIP-1α of children in the two groups after treatment were significantly lower than those before treatment (P<0.05);after treatment,the serum levels of TNF-α,IFN-γ and MIP-1α of children in the observation group were significantly lower than those in the control group (P<0.05).During the treatment,there were two cases of gastrointestinal discomfort and two cases of infection in the control group,the adverse reaction rate was 8.70% (4/46);there were two cases of local pain in the observation group,the adverse reaction rate was 4.35% (2/46);there was no significant difference in the adverse reaction rate between the two groups (χ2=0.178,P>0.05).Conclusion　The clinical efficacy of ECMO combined with gamma globulin in the treatment of children with severe adenovirus pneumonia and respiratory failure is significant,which helps to improve respiratory-related indicators,reduce inflammatory response,enhance immunity and with high safety.

参考文献/References:

［1］　LA FAY C,BOSDURE E,BARAVALLE-EINAUDI M,et al.Severe adenovirus pneumonia with hemophagocytic syndrome and respiratory failure［J］.Arch Pediatr,2020,27(7):383-385.
［2］　李攀,郎艳美,石艳玺,等.2015年-2018年住院患儿腺病毒和合胞病毒肺炎的临床特征分析［J］.中国病案,2019,20(11):93-96.
LI P,LANG Y M,SHI Y X,et al.Clinical characteristics of adenovirus and syncytial virus pneumonia in hospitalized children from 2015 to 2018［J］.Chin Med Record,2019,20(11):93-96.
［3］　WANG H,BU L,SHU F,et al.Molecular mechanism of biofilm locator protein kinase Dbf2p-related kinase 1 in regulating innate immune response to interleukin 17-induced viral pneumonia［J］.Bioengineered,2021,12(2):10335-10344.
［4］　龙思丹,季双双,周元琛,等.大剂量丙种球蛋白辅助治疗成人重症病毒性肺炎临床效果的Meta分析［J］.中国全科医学,2021,24(2):225-231.
LONG S D,JI S S,ZHOU Y S,et al.High-dose intravenous gamma globulin in the treatment of severe viral pneumonia in adults:a meta-analysis［J］.Chin Gen Prac,2021,24(2):225-231.
［5］　陈海莉,李永政,范莉莉,等.1例肺部感染合并呼吸衰竭患者使用ECMO支持治疗的药学监护［J］.药物流行病学杂志,2019,28(12):825-827.
CHEN H L,LI Y Z,FAN L L,et al.Pharmaceutical care for a case of anti-infective treatment of pneumonia with respiratory failure during extracorporeal membrane oxygenation［J］.Chin J Pharmacoepidemiol,2019,28(12):825-827.
［6］　王卫平.儿科学［M］.8版.北京:人民卫生出版社,2013:284.
WAGN W P.Pediatrics［M］.8th edition.Beijing:People′s Health Publishing House,2013:284.
［7］　冯献荣,吴楠,牛微微,等.乌司他丁联合注射用亚胺培南西司他丁钠治疗重症肺炎伴呼吸衰竭的临床效果［J］.中国医药导报,2020,17(3):123-126.
FENG X R,WU N,NIU W W,et al.Clinical effect of ulinastatin combined with imipenem and cilastatin sodium for injection in the treatment of severe pneumonia with respiratory failure［J］.Chin Med Herald,2020,17(3):123-126.
［8］　MOON S M,CHOE J,NA S J,et al.Comparative study on the effect of cidofovir treatment for severe adenovirus pneumonia［J］.J Intensive Care Med,2021,36(12):1436-1442.
［9］　杨丽君,林茹,叶莉芬,等.体外膜肺氧合治疗重症腺病毒肺炎致呼吸衰竭的临床特征及管理经验［J］.中华急诊医学杂志,2020,29(10):1360-1363.
YAGN L J,LIN R,YE L F,et al.Clinical characteristics and management experience of extracorporeal membrane oxygenation in the treatment of respiratory failure caused by severe adenovirus pneumonia［J］.Chin J Emerg Med,2020,29(10):1360-1363.
［10］　VASHISHT R,MIRZAI S,KOVAL C,et al.Adenovirus-associated acute respiratory distress syndrome:need for a protocol-based approach［J］.Indian J Crit Care Med,2020,24(5):367-368.
［11］　沈玮芸,霍丽霞,章喜林,等.不同病原体呼吸道感染患儿外周血淋巴细胞亚群差异分析［J］.浙江医学,2020,42(4):339-342,348.
SHEN W Y,HUO L X,ZHANG X L,et al.Difference in periphe-ral blood lymphocyte subsets of children with respiratory tract infection caused by different pathogens［J］.Zhejiang Med J,2020,42(4):339-342,348.
［12］　周新龙,方沛安,李聪,等.静脉注射丙种球蛋白辅助治疗儿童重症腺病毒肺炎的临床效果观察［J］.内科,2020,15(3):324-325,341.
ZHOU X L,FANG P A,LI C,et al.Clinical observation of adjuvant intravenous injection of gamma globulin in the treatment of severe adenovirus pneumonia in children［J］.Intern Med China,2020,15(3):324-325,341.
［13］　王静凛.丙种球蛋白联合抗感染佐治小儿重症腺病毒肺炎的临床疗效［J］.中国药物经济学,2019,14(7):51-54.
WANG J L.Clinical efficacy of gamma globulin combined with anti-infection in the treatment of severe adenovirus pneumonia in children［J］.Chin J Pharm Econ,2019,14(7):51-54.
［14］　张育才,崔云.体外膜肺氧合挽救儿童难治性呼吸衰竭的现状与发展［J］.中华急诊医学杂志,2020,29(6):750-753.
ZHANG Y C,CUI Y.Current status and development of extracorporeal membrane oxygenation in the rescue of children with refractory respiratory failure［J］.Chin J Emerg Med,2020,29(6):750-753.
［15］　甘艳如,春晓,马敬香,等.体外膜肺氧合治疗重症腺病毒肺炎合并急性呼吸窘迫综合征患儿的护理体会［J］.中国实用护理杂志,2020,36(11):833-837.
GAN Y Y,CHUN X,MA J X,et al.Case report of 20 cases of ECMO in the treatment of severe adenovirus pneumonia complicated with ARDs［J］.Chin J Pract Nurs,2020,36(11):833-837.
［16］　LYNCH J P 3RD,KAJON A E.Adenovirus:epidemiology,global spread of novel serotypes,and advances in treatment and prevention［J］.Semin Respir Crit Care Med,2016,37(4):586-602.
［17］　刘坤鹏,李凤榕,石燕华,等.急性呼吸道腺病毒感染患儿淋巴细胞亚群及干扰素-γ、转化生长因子-β1、白细胞介素-10水平的变化［J］.中国药物与临床,2020,20(2):280-281.
LIU K P,LI F R,SHI Y H,et al.Changes of lymphocyte subsets and interferon-γ,transforming growth factor-β1 and interleukin-10 levels in children with acute respiratory adenovirus infection［J］.Chin Remed Clin,2020,20(2):280-281.
［18］　张慧玲,徐晓晓,张晨美,等.腺病毒肺炎患儿细胞免疫及炎症因子表达及其对病情判断的临床意义［J］.中国免疫学杂志,2020,36(22):2774-2778.
ZHANG H L,XU X X,ZHANG C M,et al.Expression of cellular immunity and inflammatory factors in children with adenovirus pneumonia and its clinical significance for state diagnosing［J］.Chin J Immun,2020,36(22):2774-2778.
［19］　钱凯,邱慧明,童涌,等.腺病毒肺炎和肺炎支原体肺炎患儿肺部炎症细胞因子的表达差异研究［J］.中国妇幼保健,2020,35(12):2265-2267.
QIAN K,QIU H M,TONG Y,et al.Differences in the expression of inflammatory cytokines in the lungs of children with adenovirus pneumonia and mycoplasma pneumoniae pneumonia［J］.Maternal Child Health Care China,2020,35(12):2265-2267.
［20］　LIM J U,CHOI J Y,JENOG H J,et al.Comparison of clinical characteristics and inflammatory cytokines between hypoxemic and non-hypoxemic human adenovirus 55 pneumonia［J］.J Thorac Dis,2020,12(8):4044-4056.
［21］　张金仿,王刚,高琰,等.腺病毒肺炎患儿血清MIP-1α和外周血SOCS-1 mRNA,SOCS-3 mRNA的变化及意义［J］.临床和实验医学杂志,2020,19(15):1582-1585.
ZHANG J F,WANG G,GAO Y,et al.Changes of MIP-1α,SOCS-1 mRNA and SOCS-3 mRNA in peripheral blood of children with adenovirus pneumonia and its clinical value［J］.J Clin Exp Med,2020,19(15):1582-1585.

相似文献/References:

[1]赵畅,潘艳萍.氧气疗法治疗Ⅱ型呼吸衰竭18例[J].新乡医学院学报,1996,13(02):158.
[2]李国保.经鼻面罩压力支持通气治疗慢性阻塞性肺病呼吸衰竭[J].新乡医学院学报,2002,19(04):293.
[3]宋振风,刘志强,董静.序贯性机械通气治疗老年慢性阻塞性肺疾病重度呼吸衰竭[J].新乡医学院学报,2002,19(04):295.
[4]姜建慧,洪　敏,王海燕,等.无创正压通气治疗急性呼吸衰竭42 例护理体会[J].新乡医学院学报,2003,20(04):296.
[5]姜建慧,洪 敏,王海燕,等.无创正压通气治疗急性呼吸衰竭42例护理体会[J].新乡医学院学报,2003,20(04):296.
[6]胡继梅,徐欣欣,刘　爽.双水平气道正压通气治疗呼吸衰竭38 例护理体会[J].新乡医学院学报,2006,23(06):628.
[7]付黎明,朱　平,李春燕.纤维支气管镜吸痰灌洗联合机械排痰治疗吸入性肺炎并发呼吸衰竭疗效观察[J].新乡医学院学报,2018,35(7):612.[doi:10.7683/xxyxyxb.2018.07.016]
　FU Li-ming,ZHU Ping,LI Chun-yan.Effect of sputum suction and lavage by fiexible bronchofiberscope combined with mechanical expectoration in the treatment of patients with aspiration pneumonia complicated with respiratory failure[J].Journal of Xinxiang Medical University,2018,35(9):612.[doi:10.7683/xxyxyxb.2018.07.016]
[8]王林梅.适应性支持通气在慢性阻塞性肺疾病并发呼吸衰竭老年患者撤除呼吸机过程中的应用价值[J].新乡医学院学报,2018,35(9):810.[doi:10.7683/xxyxyxb.2018.09.015]
　WANG Lin-mei.Application value of adaptive support ventilation in respirator removal in elderly patients with chronic obstructive pulmonary disease complicated with respiratory failure[J].Journal of Xinxiang Medical University,2018,35(9):810.[doi:10.7683/xxyxyxb.2018.09.015]
[9]马群,李卫阳,许蒙.老年重症肺炎并呼吸衰竭患者血清可溶性CD40配体和正五聚体蛋白-3水平变化及临床意义[J].新乡医学院学报,2023,40(7):659.[doi:10.7683/xxyxyxb.2023.07.011]
　MA Qun,LI Weiyang,XU Meng.Changes and clinical significance of serum soluble CD40 ligand and pentraxin-3 levels in elderly patients with severe pneumonia and respiratory failure[J].Journal of Xinxiang Medical University,2023,40(9):659.[doi:10.7683/xxyxyxb.2023.07.011]

更新日期/Last Update: 2022-09-05