【摘要】 目的观察机械通气时新生儿血浆肺表面活性物质蛋白A(SP-A)和血清铁蛋白(SF)的变化,探讨其在呼吸机诱发肺损伤(VILI)中的意义。方法机械通气组使用机械通气新生儿36例,非机械通气组未使用机械通气31例。机械通气组在机械通气后1、24、48、72h和撤机后24h采集静脉血,非机械通气组在同样时段采集静脉血;采用免疫印迹法检测血浆SP-A水平,采用放射免疫方法检测SF水平。结果机械通气组通气后24、48、72h血浆SP-A水平明显高于非机械通气组;机械通气组通气后1、24、48、72h和撤机后24hSF水平显著高于非机械通气组,差异有显著性(P<0.05,0.01);且升高程度与使用机械通气天数呈显著相关性(r=0.451,0.431Pa<0.05)。机械通气后48h血浆SP-A和SF水平出现明显变化,且持续在高水平上波动,随着病情好转撤机,SP-A及SF水平渐回落。结论动态观察机械通气新生儿血浆SP-A和SF水平可能有助于监测VILI的发生,指导临床诊治。更多还原

【Abstract】 Objective To observe the changes of plasma pulmonary surfactant protein-A (SP-A) and serum ferritin (SF) in neonates with mechanical ventilation and its clinical significance in ventilation-induced lung injury (VILI).Methods The study was carried out in 36 neonates with mechanical ventilation and 31 neonates without mechanical ventilation .Plasma SP-A and SF levels in venous blood were mea- sured on 1,24,48,72 hours after mechanical ventilation and 24 hours after mechanical ventilation removal by Western-dot blot and radioimmunoassay (RIA).Plasma SP-A and SF levels of non-mechanical ventilation group were determined at the same time.Results Plasma SP-A levels in neonates on 24,48,72 hours after mechanical ventilation were significantly higher than those of non-mechanical ventilation group[( 2.20± 0.22)vs(1.97±0.29) μg/L,(2.43±0.28)vs(1.94±0.33) μg/L,(2.61±0.38)vs(1.80±0.34) μg/L,respectively P<0.05, 0.01],and SF level in neonates on 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)vs(2.38±0.31)μg/L,(2.79±0.41)vs(2.34± 0.39 )μg/L,(2.93±0.45)vs(2.28±0.26)μg/L,(3.16±0.38)vs(2.23±0.30)μg/L,(2.57±0.51)vs(2.20±0.40)μg/L,respectively P<0.05,<0.01].Plasma SP-A and SF levels were correlated with the use of mechanical ventilation and the days requiring mecha- nical ventilation(r=0.451,0.431,respectively P_a<0.05). Plasma SP-A and SF levels in neonates on 48 hours after mechanical ventilation were obviously elevated.Plasma SP-A and SF levels were prolonged elevation after mechanical ventilation.Conclusion Evaluating plasma SP-A and SF levels in neonate after mechanical ventilation may help monitor the development and guid the clinical diagnosis and treatment of VILI.更多还原