[1]赵杰,朱萍,苌俊明,等.不同机械通气方式联合猪肺磷脂注射液治疗新生儿呼吸衰竭疗效比较[J].新乡医学院学报,2023,40(1):067-72.[doi:10.7683/xxyxyxb.2023.01.012]
　ZHAO Jie,ZHU Ping,CHANG Junming,et al.Comparison of the efficacy of different mechanical ventilation combined with porcine lung phospholipid injection in the treatment of neonatal respiratory failure[J].Journal of Xinxiang Medical University,2023,40(1):067-72.[doi:10.7683/xxyxyxb.2023.01.012]
点击复制

不同机械通气方式联合猪肺磷脂注射液治疗新生儿呼吸衰竭疗效比较
分享到：

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

卷:
40卷
期数:
2023年1期
页码:
067-72
栏目:
临床研究
出版日期:
2023-01-05

文章信息/Info

Title:
Comparison of the efficacy of different mechanical ventilation combined with porcine lung phospholipid injection in the treatment of neonatal respiratory failure
作者:
赵杰; 朱萍; 苌俊明; 别静洋; 李德亮; 王海云; 杨柳
（南阳市中心医院新生儿重症监护病区，河南　南阳　473005）
Author(s):
ZHAO Jie; ZHU Ping; CHANG Junming; BIE Jingyang; LI Deliang; WANG Haiyun; YANG Liu
(Neonatal Intensive Care Unit,Nanyang Central Hospital,Nanyang 473005,Henan Province,China)
关键词:
猪肺磷脂注射液; 常频机械通气; 高频振荡通气; 新生儿呼吸衰竭
Keywords:
porcine lung phospholipid injection; conventional mechanical ventilation; high-frequency oscillatory ventilation; neonatal respiratory failure
分类号:
R722.1
DOI:
10.7683/xxyxyxb.2023.01.012
文献标志码:
A
摘要:
目的　比较常频机械通气（CMV）、猪肺磷脂注射液联合CMV、猪肺磷脂注射液联合高频振荡通气（HFOV）治疗新生儿呼吸衰竭的疗效。方法　选择2019年1月至2020年12月南阳市中心医院收治的133例呼吸衰竭新生儿为研究对象，根据治疗方式将患儿分为对照组（n=41）、观察组A（n=45）和观察组B（n=47）。对照组患儿给予单纯CMV治疗，观察组A患儿给予猪肺磷脂注射液联合HFOV治疗，观察组B患儿给予猪肺磷脂注射液联合CMV治疗。比较3组患儿机械通气时间、用氧时间、治疗前后的呼吸力学指标［动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（OI）、呼吸指数（RI）］和血清内皮素-1（ET-1）、 肌酸激酶同工酶（CK-MB）、Ⅱ型肺泡表面抗原-6（KL-6）、Clara细胞蛋白16（CC16）水平及不良反应发生情况。结果　3组患儿的机械通气时间和用氧时间比较差异有统计学意义（F=12.658、26.196，P<0.05）；观察组A和观察组B患儿的机械通气时间和用氧时间显著短于对照组（P<0.05），观察组A患儿的机械通气时间和用氧时间显著短于观察组B（P<0.05）。3组患儿治疗12、24、48、72 h的PaO2显著高于治疗前，PaCO2、RI、OI显著低于治疗前（P<0.05）。治疗12、24、48 h，观察组A和观察组B患儿的PaO2显著高于对照组，观察组A患儿的PaO2显著高于观察组B（P<0.05）；治疗12、24、48 h，观察组A和观察组B患儿的PaCO2显著低于对照组，观察组A患儿的PaCO2显著低于观察组B（P<0.05）；治疗12、24、48、72 h，观察组A和观察组B患儿的RI、OI显著低于对照组，观察组A患儿的RI、OI显著低于观察组B（P<0.05）。治疗前，3组患儿血清ET-1、CK-MB、KL-6、CC16比较差异均无统计学意义（P>0.05）；3组患儿治疗72 h血清ET-1、CK-MB、KL-6、CC16显著低于治疗前（P<0.05）；治疗72 h，观察组A和观察组B患儿血清ET-1、CK-MB、KL-6、CC16显著低于对照组，观察组A患儿血清ET-1、CK-MB、KL-6、CC16显著低于观察组B（P<0.05）。对照组、观察组A和观察组B患儿总不良反应发生率分别为43.90%（18/41）、20.00%（9/45）、27.66%（13/47），3组患儿总不良反应发生率比较差异有统计学意义（χ2=4.859，P<0.05）。观察组A患儿总不良反应发生率显著低于对照组（χ2=3.265,P<0.05）；观察组A与观察组B患儿总不良反应发生率比较差异无统计学意义（χ2=1.827,P>0.05）；观察组B与对照组患儿总不良反应发生率比较差异无统计学意义（χ2=1.034,P>0.05）。结论　与单纯CMV、猪肺磷脂注射液联合CMV治疗相比较，猪肺磷脂注射液联合HFOV治疗新生儿呼吸衰竭可更有效地缩短机械通气和用氧时间，降低血清ET-1、CK-MB、KL-6、CC16水平，改善氧合功能，减轻炎症反应及其对心肌细胞的损伤，减少不良反应。
Abstract:
Objective　To compare the efficacy of conventional mechanical ventilation (CMV)，porcine lung phospholipid injection combined with CMV，porcine lung phospholipid injection combined with high-frequency oscillatory ventilation (HFOV) in the treatment of neonatal respiratory failure.Methods　A total of 133 newborns with respiratory failure admitted to Nanyang Central Hospital from January 2019 to December 2020 were selected as the research objects,and the children were divided into the control group (n=41)，observation group A (n=45) and observation group B (n=47) according to the different treatment methods.The children in the control group were given CMV treatment，the children in the observation group A were given porcine lung phospholipid injection combined with HFOV treatment，and the children in the observation group B were given porcine lung phospholipid injection combined with CMV treatment.The time of mechanical ventilation,time of oxygen use,the respiratory mechanics indexes［including the arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2)，oxygenation index (OI) and respiratory index (RI)］ and serum endothelin-1 (ET-1)，creatine kinase isoenzyme (CK-MB)，krebs yon denlundgen-6 (KL-6)，Clara cell secretory protein 16 (CC16) as well as the occurrence of adverse reactions of the children among the three groups were compared.Results　There were significant difference in the time of mechanical ventilation and time of oxygen use of the children among the three groups (F=12.658,26.196;P<0.05);the time of mechanical ventilation and time of oxygen use of children in the observation group A and observation group B were significantly shorter than those in the control group (P<0.05)，and the time of mechanical ventilation and time of oxygen use of children in the observation group A were significantly shorter than those in observation group B (P<0.05).At 12，24，48 and 72 hours of treatment,the PaO2 was significantly higher than that before treatment，and PaCO2，RI,OI were significantly lower than those before treatment in the three groups (P<0.05).At 12，24 and 48 hours of treatment，the PaO2 of children in the observation group A and observation group B was significantly higher than that in the control group，and the PaO2 of children in the observation group A was significantly higher than that in the observation group B (P<0.05);at 12，24 and 48 hours of treatment，the PaCO2 of children in the observation group A and observation group B was significantly lower than that in the control group，and the PaCO2 of children in the observation group A was significantly lower than that in the observation group B (P<0.05);at 12,24,48,72 hours of treatment,the RI and OI of children in the observation group A and observation group B were significantly lower than those in the control group，and the RI and OI of children in the observation group A were significantly lower than those in the observation group B (P<0.05).Before treatment，there was no significant difference in serum ET-1，CK-MB，KL-6 and CC16 levels of children among the three groups (P>0.05);the levels of serum ET-1，CK-MB，KL-6 and CC16 of children at 72 hours of treatment were significantly lower than those before treatment in the three groups (P<0.05);at 72 hours of treatment，the levels of serum ET-1，CK-MB，KL-6 and CC16 of children in the observation group A and observation group B were significantly lower than those in the control group，and the levels of serum ET-1，CK-MB，KL-6 and CC16 of children in the observation group A were significantly lower than those in the observation group B (P<0.05).The total adverse reaction rates of children in the control group，observation group A and observation group B were 43.90% (18/41)，20.00% (9/45) and 27.66% (13/47)，respectively.There were significant difference in the total adverse reaction rates among the three groups(χ2=4.859,P<0.05);the total adverse reaction rate of children in observation group A was significantly lower than that in the control group (P<0.05);there was no significant difference in the total adverse reaction rate between the observation group A and observation group B (χ2=1.827,P>0.05);and there was no significant difference in the total adverse reaction rate between observation group B and control group (χ2=1.034,P>0.05).Conclusion　Compared with CMV and porcine lung phospholipid injection combined with CMV therapy，porcine lung phospholipid injection combined with HFOV in the treatment of neonatal respiratory failure can more effectively shorten the time of mechanical ventilation and oxygen use,reduce the serum ET-1，CK-MB，KL-6，CC16 levels，improve oxygenation function，reduce inflammation and damage to myocardial cells，and reduce the adverse reactions.

参考文献/References:

［1］　杭菲菲,卢刻羽,吴新萍,等.呼吸衰竭新生儿放弃治疗的影响因素分析［J］.中国当代儿科杂志,2021,23(6):588-592.
HANG F F,LU K Y,WU X P,et al.Contributing factors for the withdrawal from treatment in neonates with respiratory failure［J］.Chin J Contemp Pediatr,2021,23(6):588-592.
［2］　NING B,LIANG L,LYU Y,et al.The effect of high-frequency oscillatory ventilation or airway pressure release ventilation on children with acute respiratory distress syndrome as a rescue therapy［J］.Transl Pediatr,2020，9(3):213-220.
［3］　宋文奇,余金蓉,陈莉.猪肺磷脂注射液与氨溴索分别联合经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征的疗效［J］.儿科药学杂志,2019,25(10):26-29.
SONG W Q,YU J R,CHEN L.Poractant alfa injection or ambroxol combined with nasal continuous positive airway pressure in the treatment of respiratory distress syndrome［J］.J Pediatr Pharm,2019,25(10)：26-29.
［4］　王智灵,刘敏,张莉,等.猪肺磷脂注射液配合常规疗法对呼吸窘迫新生儿支气管肺发育不良及PLTP,MIF的影响［J］.临床肺科杂志,2019，24(12):2188-2191.
WANG Z L,LIU M,ZHANG L,et al.Effect of porcine lung phospholipid injection combined with conventional therapy on bronchopulmonary dysplasia and PLTP and MIF in neonates with respiratory distress［J］.J Clin Pulm Med,2019,24(12):2188-2191.
［5］　邵肖梅,叶鸿瑁,丘小汕.实用新生儿学［M］.4版.北京:人民卫生出版社,2011：423-424.
XIAO X M，YE H M，QIU X S.Practical neonatology［M］.4th ed.Beijing:People′s Health Publishing House，2011：423-424.
［6］　王俊,陈竹芳.持续正压通气呼吸机联合氨溴索治疗ICU呼吸衰竭新生儿的疗效［J］.中国妇幼保健，2020，35(21):4016-4018.
WANG J,CHEN Z F.Efficacy of continuous positive pressure ventilation ventilator combined with ambroxol in treatment of neonates with ICU respiratory failure［J］.Matern Child Health Care China,2020，35(21):4016- 4018.
［7］　黄莺,皮小芹,陈小茜.CPAP联合维生素营养支持治疗新生儿呼吸衰竭的效果观察［J］.川北医学院学报，2019，34(4):388-391.
HUANG Y,PI X Q,CHEN X Q.Effect of CPAP combined with vitamin nutritional support in the treatment of neonatal respiratory failure［J］.J North Sichuan Med Coll,2019，34(4):388-391.
［8］　林勇,孙晓玄,许楠.布地奈德联合猪肺磷脂注射液对重度新生儿呼吸窘迫综合征患儿肺功能的影响［J］.药物评价研究,2019，42(9):1835-1838.
LIN Y，SUN X X，XU N.Effects of budesonide combined with poractant alfa injection on pulmonary function in children with severe neonatal respiratory distress syndrome［J］.Drug Evaluat Res,2019,42(9)：1835-1838.
［9］　刘艳妮,姚艳粉.猪肺磷脂注射液联合经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床疗效及其对血清人高迁移率族蛋白B1、重组人巨噬细胞移动抑制因子水平的影响［J］.实用心脑肺血管病杂志,2019,27(6):94-97.
LIU Y N,YAO Y F.Clinical effect of poractant alfa injection combined with nasal intermittent positive pressure ventilation on neonatal respiratory distress syndrome and the impact on serum levels of HMGB1 and MIF1［J］.Pract J Cardiac Cerebr Pneum Vasc Dis,2019，27(6):94-97.
［10］　CHEN L J,CHEN J Y.Effect of high-frequency oscillatory ventilation combined with volume guarantee on preterm infants with hypoxic respiratory failure.［J］.J Chin Med Assoc,2019，82(11):861-864.
［11］　庞登戈,冯继峰,罗碧君,等.七氟醚吸入对危重新生儿术中肺表面活性蛋白A和B的影响［J］.临床麻醉学杂志,2019，35(10):991-994.
PANG D G,FENG J F,LUO B J,et al.Expression of surfactant protein A and B during the operation for critical newborn with sevoflurane inhalation［J］.J Clin Anesthesiol,2019，35(10):991-994.
［12］　李玲,薛梅.一氧化氮吸入联合高频震荡通气治疗新生儿严重呼吸衰竭的疗效分析［J］.安徽医药，2019,23(3):588-590.
LI L，XUE M.Efficacy of combination therapy with inhaled nitric oxide and high-frequency oscillation ventilation in the treatment of neonatal hypoxemic respiratory failure［J］.Anhui Med Pharmaceut J,2019，23(3):588-590.
［13］　TANA M,PALADINI A,TIRONE C,et al.Effects of high-frequency oscillatory ventilation with volume guarantee during surfactant treatment in extremely low gestational age newborns with respiratory distress syndrome：an observational study［J］.Front Pediatr,2022,9:804807.
［14］　IDRIS I,SINRANG A W，ARSYAD A,et al.The rise of circulatory endothelin (ET)-1 and endothelin receptors (ETA，ETB) expression in kidney of obese wistar rat［J］.Int J Physiol Pathophysiol Pharmacol，2019，11(2):31-35.
［15］　ZHANG J,TANG H,WANG Y,et al.Clinical values of creatine kinase and its isoenzymes in children and adolescents with vasovagal syncope［J］.Nutr Metab Cardiovasc Dis,2020,30(10):1848-1854.
［16］　沈嘉渝,张尔永,胡佳.KL-6与体外循环中行持续低潮气量通气的成年瓣膜患者围术期肺氧合功能改变的相关性研究［J］.四川大学学报（医学版）,2019，50(3):350-356.
SHEN J Y,ZHANG EY,HU J.Correlation of krebs von den lungen-6(KL-6) expression and perioperative pulmonary function in adults receiving continuing low-volume ventilation during valve surgery［J］.J Sichuan Univ(Med Sci)，2019，50(3):350-356.
［17］　EGRON C,LABB A,ROCHETTE E,et al.Urinary club cell protein 16 (CC16):utility of its assay during acute bronchiolitis［J］.Pediatr Pulmonol，2019，55(2)：490-495.
［18］　原静,李书芳,李亚菲,等.无创高频振荡通气对新生儿呼吸衰竭外周血CC16与KL-6表达的影响［J］.中国现代医学杂志,2020，30(4):93-97.
YUAN J，LI S F，LI Y F，et al.Effect of nHFOV on the level of CC16 and KL-6 in neonatal acute respiratory failure［J］.China J Modern Med,2020，30(4):93-97.
［19］　YANG G,QIAO Y,SUN X,et al.The clinical effects of high-frequency oscillatory ventilation in the treatment of neonatal severe meconium aspiration syndrome complicated with severe acute respiratory distress syndrome［J］.BMC Pediatr，2021,21(1):560.

更新日期/Last Update: 2023-01-05