摘要
目的探讨压力支持通气(PSV)联合容量保证通气(VGV)模式与同步间歇指令通气(SIMV)联合VGV模式,对早产儿呼吸窘迫综合征(RDS)的疗效,以及白细胞介素(IL)-17对RDS早产儿预后判断价值。方法选择2013年1月1日至2017年6月30日,广西壮族自治区妇幼保健院新生儿重症监护病房(NICU)收治的68例出生时胎龄<37周的RDS早产儿为研究对象。通过在线随机分配网站,将68例早产儿随机分为SIMV+VGV组(n=34,接受SIMV+VGV模式治疗)与PSV+VGV组(n=34,接受PSV+VGV模式治疗)。对所有早产儿均于出生后2～12h内,采用肺表面活性物质治疗。采用酶联免疫吸附测定(ELISA)法,检测所有早产儿机械通气治疗前及治疗后(出生28d后)血清IL-17水平。采用成组t检验,对2组早产儿出生胎龄、出生体重及机械通气治疗前、后血清IL-17水平等进行统计学比较。采用χ~2检验或连续性校正χ~2检验,对2组早产儿性别、娩出方式构成比,早产儿脑室出血、早产儿视网膜病、气管拔管后肺不张发生率,氧依赖率、再插管率、死亡率及母亲产前激素使用率等进行比较。绘制机械通气治疗前血清IL-17水平预测RDS早产儿预后(死亡、存活)的受试者工作特征(ROC)曲线,计算ROC曲线下面积(ROC-AUC),根据约登指数最大原则,确定机械通气治疗前血清IL-17水平预测RDS早产儿预后的最佳临界值,并计算其敏感度和特异度。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果 (1)2组早产儿出生胎龄、出生体重,性别、娩出方式构成比,早产儿机械通气治疗前血清IL-17水平及母亲产前激素使用率等一般临床资料比较,差异均无统计学意义(P>0.05)。(2)PSV+VGV组RDS早产儿出生28d后的氧依赖率、气管拔管后肺不张发生率、再插管率分别为5.9%(2/34)、8.8%(3/34)、2.9%(1/34),均显著低于SIMV+VGV组的23.5%(8/34)、35.3%(12/34)、67.6%(23/34),2组比较,差异均有
Objective To investigate the treatment outcomes of pressure support ventilation(PSV)combined with volume guarantee ventilation(VGV)mode and synchronized intermittent mandatory ventilation(SIMV)combined with VGV mode on respiratory distress syndrome(RDS)in premature infants,and explore predictive value of interleukin(IL)-17 in predicting prognosis of premature infants with RDS.Methods A total of 68 premature infants with RDS and gestational ages at birth<37 weeks in neonatal intensive care unit(NICU)of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from January 1,2013 to June 30,2017 were enrolled as research subjects.The subjects were randomly assigned into SIMV+VGV group(n=34,received SIMV combined with VGV treatment)and PSV+VGV group(n=34,received PSV combined with VGV treatment)by online random assignment.All premature infants were treated with pulmonary surfactant within 2 to 12 hours after birth.Serum IL-17 levels of all preterm infants were measured by enzyme-linked immunosorbent assay(ELISA)before and after mechanical ventilation(28 days after birth).Statistical analysis was performed on the gestational age at birth,birth weight,and serum IL-17 levels before and after treatment by independent-samples t test between two groups.Chi-square test or continuous correction chi-square test was performed to compare the constituent ratios of gender and delivery mode,incidences of intraventricular hemorrhage,retinopathy of prematurity and atelectasis after tracheal intubation,and rates of oxygen dependence and tracheal reintubation,and mortality of premature infants,and maternal prenatal hormone use rate,etc.between two groups.To predict prognosis(death or survival)of preterm infants with RDS,receiver operating characteristic(ROC)curve of serum IL-17 level before mechanical ventilation treatment in predicting prognosis(death or survival)of premature infants with RDS was plotted.And the area under ROC curve(ROC-AUC)was calculated.The optimal cut-off point of serum IL-17 level before mechanical
作者
邱玉芬
高晓燕
李凌霄
奚碧冰
陆月合
Qiu Yufen;Gao Xiaoyan;Li Lingxiao;Xi Bibing;Lu Yuehe(Department of Neonatology,Xiangzhu Branch of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,Guangxi Zhuang Autonomous Region,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2018年第6期649-655,共7页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
广西壮族自治区卫生计生委基金项目(Z2016091)~~
关键词
呼吸窘迫综合征
新生儿
呼吸
人工
容量保证通气
压力支持通气
白细胞介素类
预后
婴儿
早产
Respiratory distress syndrome,newborn
Respiration,artificial
Volume guarantee ventilation
Pressure support ventilation
Interleukins
Prognosis
Infant,premature
