呼吸衰竭足月儿临床分析及早期血清细胞因子、SPs监测

发布时间：2018-06-06 15:02

本文选题：呼吸衰竭 + 机械通气　；参考：《南方医科大学》2017年硕士论文

【摘要】：新生儿呼吸衰竭(neonatal respiratory failure,NRF)是新生儿重症监护室(NICU)中的常见危重症,可由多种原发疾病引起,常伴有急性肺损伤,具有高发病率、高病死率和高费用的特点,是导致新生儿致死及致残的最常见原因。尽管国内外已有对NRF的临床流行病学调查,但对呼吸衰竭需机械通气足月儿救治现状的研究极少,有待进行相关临床研究,以总结临床经验。另外,目前普遍认为炎症细胞因子介导了急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)的发病机制,肺表面活性物质(PS)质和量的改变是呼吸衰竭的一个重要发病环节,而呼吸衰竭与ALI/ARDS关系密切,呼吸衰竭足月儿早期血清细胞因子及肺泡表面活性蛋白(SPs)水平有无改变,两者之间有无相互关系,尚待探讨,本文针对以上问题进行了相关研究。第一部分呼吸衰竭足月儿的临床分析目的:了解呼吸衰竭需机械通气足月儿目前的救治现状,总结临床治疗经验。方法:收集2015年6月至2015年12月在我院足月儿NICU住院治疗的79例呼吸衰竭需机械通气足月新生儿的临床资料,进行统计学分析。结果:我院呼吸衰竭需机械通气足月儿男/女性别比为2.04:1(53/26),原发疾病以肺部感染/败血症(36.71%)、窒息(25.32%)和胎粪吸入综合征(MAS,13.92%)较常见。79例患儿的PS使用率为45.57%(36/79),NO使用率为32.91%(26/79),发病率为7.14%(79/1107),病死率为18.99%(15/79),NO吸入组病死率高于呼吸机组及呼吸机+PS组(x2=14.753,P=0.001)。结论:我院呼吸衰竭足月儿中男性居多,肺部感染/败血症、室息及MAS为主要原发疾病,机械通气、补充PS及NO吸入是主要救治手段,PS及NO治疗的普及可降低病死率,但其发病率及病死率仍然较高,且需NO吸入治疗组患儿的病情更重。第二部分呼吸衰竭足月儿早期血清细胞因子、SPs监测及意义目的:本研究旨在通过分析呼吸衰竭足月儿早期血清细胞因子、SPs的水平及相互关系,探讨两者早期监测的临床意义。方法:随机选取2016年10月至2016年12月我院30例呼吸衰竭需机械通气足月儿为病例组,30例“健康”足月儿为对照组,根据预后再将病例组分为存活组及死亡组,所有病例入院第一天采血,病例组入院第三天再次采血,用流式细胞仪检测细胞因子,酶联免疫吸附法(ELISA法)检测血清SPs,进行统计学分析。结果:病例组IL-6、IL-10、SP-A、SP-B及SP-C水平显著高于对照组(t=2.498～5.213,P0.05),且IL-6、SP-A与呼吸衰竭诊断间高度相关(r=0.845～0.866,P0.05)。血清IL-6与SP-A、SP-C水平呈高度正相关(r=0.920～0.984,P0.05),SP-A及SP-C水平亦呈高度正相关(r=0.955,P0.05)。IL-6、SP-A、SP-C水平,在入院第一天死亡组显著高于存活组(z=-3.173～-3.172,P0.05),存活组入院第三天显著低于第一天(t=2.892～4.295,P0.05),需NO吸入治疗组水平显著高于需PS治疗组及单纯呼吸机治疗组(X2=9.077～12.751,P0.05)。结论:血清IL-6、IL-10、SP-A、SP-B、SP-C可能参与其发病过程,且IL-6及SP-A与呼吸衰竭的发生关系更密切,有望成为呼吸衰竭诊断的早期参考指标。IL-6可能通过影响SP-A、SP-C的表达产生致病作用,且SP-A及SP-C之间可能也存在互相影响。血清IL-6、SP-A及SP-C水平对判断病情、了解疗效、评估预后有一定程度的临床指导意义,需NO吸入治疗的呼吸衰竭患儿病情更重,病死率更高。
[Abstract]:Neonatal respiratory failure (neonatal respiratory failure, NRF) is a common critical disease in neonatal intensive care unit (NICU), which can be caused by a variety of primary diseases, often accompanied by acute lung injury, with high morbidity, high mortality and high cost, which is the most common cause of death and disability of newborn infants. Although NRF at home and abroad However, there are few studies on the status of the treatment of respiratory failure with mechanical ventilation, but the clinical study is needed to summarize the clinical experience. In addition, it is widely believed that inflammatory cytokines mediate the pathogenesis of acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) and pulmonary surfactant (PS). The change of quality and quantity is an important link of respiratory failure, and respiratory failure is closely related to ALI/ARDS. There is no change in the level of serum cytokines and alveolar surface active protein (SPs) in the early stage of respiratory failure, and there is no relationship between them. The first part of this paper is related to the above problems. Clinical analysis of full moon children with respiratory failure: to understand the current treatment status of respiratory failure and to summarize the experience of clinical treatment. Methods: to collect the clinical data of 79 cases of respiratory failure in the foot month of NICU in our hospital from June 2015 to December 2015. The results were statistically analyzed. Respiratory failure in our hospital requires mechanical ventilation for men / women with 2.04:1 (53/26), primary diseases with pulmonary infection / septicemia (36.71%), asphyxia (25.32%) and meconium aspiration syndrome (MAS, 13.92%) more than common.79 cases, PS use rate is 45.57% (36/79), NO use rate is 32.91% (26/79), incidence rate is 7.14% (79/1107), and mortality is 18.99% (1) 5/79), the mortality rate of NO inhalation group was higher than that of the respiratory and ventilator +PS group (x2=14.753, P=0.001). Conclusion: the majority of men in the foot month of respiratory failure in our hospital, pulmonary infection / sepsis, ventricular interest and MAS are the main primary diseases, mechanical ventilation, supplemental PS and NO inhalation are the main means of rescue, and the prevalence of PS and NO treatment can reduce the mortality, but the incidence of the disease is reduced. And the mortality rate is still higher, and the condition of NO inhalation treatment group is more serious. Second part of the early serum cytokines, SPs monitoring and significance aim: the purpose of this study is to analyze the level and relationship of serum cytokines and SPs in the early stage of respiratory failure, and to explore the clinical significance of early monitoring. Method: 30 cases of respiratory failure in our hospital from October 2016 to December 2016 were randomly selected as the case group of mechanical ventilation foot months. 30 cases of "healthy" foot moon were used as the control group. According to the prognosis, the case group was divided into the survival group and the death group. All the cases were collected on the first day of admission to the hospital. The case group was collected again for third days in the hospital, and the cells were detected by flow cytometry. The serum SPs was detected by enzyme linked immunosorbent assay (ELISA). The results showed that the level of IL-6, IL-10, SP-A, SP-B and SP-C in the case group was significantly higher than that of the control group (t=2.498 ~ 5.213, P0.05), and IL-6, SP-A was highly correlated with the diagnosis of respiratory failure (r=0.845 ~ 0.866). 0.984, P0.05), the level of SP-A and SP-C also showed high positive correlation (r=0.955, P0.05).IL-6, SP-A, SP-C level. In the first day of admission, the death group was significantly higher than the survival group (z=-3.173 ~ -3.172, P0.05). The survival group was significantly lower than the first day (t=2.892 ~ 4.295), and the level of inhalation treatment group was significantly higher than that of the treatment group and simple breathing. Conclusion: serum IL-6, IL-10, SP-A, SP-B, SP-C may be involved in the pathogenesis of IL-6, IL-10, SP-A, SP-B, SP-C, and IL-6 and SP-A are more closely related to the occurrence of respiratory failure. It is expected to be an early reference index for the diagnosis of respiratory failure..IL-6 may be influenced by SP-A, the expression of SP-C may be pathogenic. The level of serum IL-6, SP-A and SP-C has a certain clinical guiding significance in judging the condition, understanding the curative effect and evaluating the prognosis. The patients with respiratory failure with NO inhalation are more serious and more fatality.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.1

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