【摘要】 目的:观察机械通气对新生儿血浆和支气管肺泡灌洗液(BALF)中肺表面活性物质蛋白A(SP-A)及血清铁蛋白(SF)的影响,探讨其在机械通气肺损伤(VILI)中的作用及其临床意义。方法:选择机械通气新生儿36例为机械通气组,未使用机械通气新生儿31例为非机械通气组。动态观察机械通气组患儿在机械通气后1、24、48、72h和撤机后24h血浆SP-A和SF水平及在机械通气后1、24、48、72hBALF中SP-A在各时段的变化,非机械通气组也以同样时段采集静脉血及BALF,用免疫印迹法检测血浆及BALF中SP-A水平,用放射免疫方法检测SF水平。应用SPSS10.0统计学软件进行统计学处理,所有数值以均数±标准差(x±s)表示;相关性分析应用直线相关公式计算关联系数r值。结果:机械通气组患儿血浆SP-A和SF水平明显升高,BALF中SP-A水平显著降低,与非机械通气组比较差异有显著性意义(P<0.05,P<0.01),且升高程度与使用机械通气天数呈显著相关性(r=0.451、-0.386、0.431,P<0.05)。机械通气后48h血浆和BALF中SP-A及SF水平出现明显变化,随着病情好转撤机,血浆SP-A及SF水平逐渐回落,提示机械通气后48h患儿可能开始出现肺损伤。结论:动态观察新生儿机械通气时血浆和BALF中SP-A及SF水平可能有助于监测VILI的发生,以指导临床诊治。更多还原

【Abstract】 Objective:To explore plasma and bronchoalveolar lavage fluid(BALF) surfactant-associated proteins-A(SP-A) and serum ferritin(SF) levels and the development of ventilation-induced lung injury(VILI) that occurs in neonate,and to investigated the effect of mechanical ventilation on plasma and BALF SP-A and SF levels response of newborns.Methods:The study was carried out in 36 neonates with mechanical ventilation and 31 neonates without mechanical ventilation in neonate intensive care unit(NICU).Plasma SP-A and SF levels were observed dynamically in 1,24,48,72 hours after initiation of mechanical ventilation and 24 hours to removed mechanical ventilation,and BALF SP-A levels were observed dynamically at 1,24,48,72 hours after initiation of mechanical ventilation by western-dot blot and radioimmunoassay(RIA).Plasma and BALF SP-A and SF levels in non-mechanical ventilation group were determined at the same time.We took the statistic analysis with SPSS10.0 statistic software.All values were presented as(x±s) and the correlation analysis was taken with linear correlation formula.Results:Plasma SP-A level in neonates at 24,48,72 hours after mechanical ventilation were significantly higher than those of non-mechanical ventilation group 〔(2.20±0.22) μg/L vs.(1.97±0.29) μg/L,(2.43±0.28) μg/L vs.(1.94±0.33) μg/L,(2.61±0.38) μg/L vs.(1.80±0.34) μg/L respectively,P<0.05,P<0.01〕,and SF level in neonates at 1,24,48,72 hours after mechanical ventilation and 24 hours after mechanical ventilation removal were obviously higher than those of non-mechanical ventilation group 〔(2.67±0.44) μg/L vs.(2.38±0.31) μg/L,(2.79±0.41) μg/L vs.(2.34±0.39) μg/L,(2.93±0.45) μg/L vs.(2.28±0.26) μg/L,(3.16±0.38)μg/L vs.(2.23±0.30) μg/L,(2.57±0.51) μg/L vs.(2.20±0.40)μg/L respectively,P<0.05,P<0.01〕.BALF SP-A levels in mechanical ventilation groups were obviously decreased than these of control group 〔(4.82±1.57) μg/ml vs.(5.79±2.04) μg/ml,(3.43±0.96) μg/ml vs.(5.43±2.05) μg/ml,(2.95±0.70) μg/ml vs.(5.82±2.08) μg/ml respectively,P<0.05,P<0.01〕.We found that plasma and BALF SP-A and SF levels correlated with mechanical ventilation and the days requiring mechanical ventilation(r=0.451,-0.386,0.431 respectively,P<0.05).Plasma and BALF SP-A and SF levels in neonates at 48 hours after mechanical ventilation had obviously changed.Plasma SP-A and SF levels in neonates at 48 hours after mechanical ventilation were obviously elevated.Plasma SP-A and SF levels were prolonged elevation after mechanical ventilation.Conclusion:Plasma and BALF SP-A and SF levels in neonates at 48 hours after mechanical ventilation may help us to monitor the development of VILI.Therefore,evaluating plasma and BALF SP-A and SF levels in neonate after mechanical ventilation may help monitor the development of VILI and the clinical diagnosis and treatment of VILI.更多还原