N-乙酰半胱氨酸联合肺表面活性物质对新生儿重症胎粪吸入综合征的疗效及其对胎儿炎症因子及氧合功能的影响

doi:10.12092/j.issn.1009-2501.2020.01.012

摘要/Abstract

摘要： 目的:分析N-乙酰半胱氨酸（NAC）联合肺泡表面活性物质（PS）对胎粪吸入综合征（MAS）患儿疗效及血清炎症因子和氧合功能影响。方法:选取2017年3月-2019年3月间在本院接受治疗的重症MAS患儿68例，随机数字表法分成对照组（34例）行抗感染与呼吸机辅助治疗，观察组（34例）在对照组基础上采用PS治疗并雾化吸入NAC雾化液。观察患儿平均气道压（MAP）、阻力（Raw）、顺应性（Cydn）、肺功能指标、血清白细胞介素-8（IL-8）、IL-10、血小板源性生长因子（PDGF）、血管内皮生长因子（VEGF）含量，记录患儿住院时间、氧暴露时间、上呼吸机时间和并发症情况。结果:24 h观察组患儿Raw、MAP较0 h、对照组降低，Cydn较0 h、对照组升高；72 h观察组患儿Raw、MAP较24 h、对照组降低，Cydn较24 h、对照组升高，差异有统计学意义（P＜0.05）；治疗后1 h、12 h、24 h观察组患儿动脉血二氧化碳分压（PaCO2）、动脉氧分压（PaO2）、动脉/肺泡氧分压（a/APO2）较对照组升高，氧合功能指数（OI）较对照组降低，差异有统计学意义（P＜0.05）；治疗后24 h观察组患儿血清IL-10含量高于对照组，血清IL-8含量低于对照组，差异有统计学意义（P＜0.05）；治疗后24 h、72 h观察组患儿血清PDGF、VEGF含量较对照组降低，差异有统计学意义（P＜0.05）。结论:乙酰半胱氨酸联合肺表面活性物质可显著提升胎粪吸入综合征患儿临床疗效，可能通过调节VEGF和PDGF表达抑制肺部炎症反应，从而改善患儿肺功能。

关键词: 胎粪吸入综合征, 肺表面活性物质, 乙酰半胱氨酸, 氧合功能, 炎症因子

Abstract: AIM: To analyze the effects of N-acetylcysteine (NAC) combined with alveolar surfactant (PS) on the efficacy and serum inflammatory factors and oxygenation in children with meconium aspiration syndrome (MAS). METHODS: Sixty-eight children with severe MAS who were treated in our hospital from March 2017 to March 2019 were enrolled. The patients were randomly divided into the control group (34 cases) for anti-infection and ventilator-assisted treatment. PS treatment was used on the basis of the control group and the NAC nebulizing solution was inhaled. The mean airway pressure (MAP), resistance (Raw), compliance (Cydn), lung function index, serum interleukin-8 (IL-8), IL-10, and platelet-derived growth factor (PDGF) were observed. Vascular endothelial growth factor (VEGF) levels were recorded, and the hospital stay, oxygen exposure time, upper ventilator time, and complications were recorded. RESULTS:During the 24 h observation group, Raw and MAP were lower than 0 h, the control group was lower, Cydn was higher than 0 h, and the control group was increased. In 72 h, the Raw and MAP of the observation group were lower than that of the control group, the Cydn was lower than that of the control group, and the Cydn was higher than the control group. The difference was statistically significant (P＜0.05). PaCO2, PaO2, a/APO2 in the observation group were higher than those in the control group at 1 h, 12 h and 24 h after treatment. The OI was lower than the control group, the difference was statistically significant (P＜0.05). The serum IL-10 level in the observation group was higher than that in the control group at 24 hours after treatment, and the serum IL-8 level was lower than that in the control group (P＜0.05). The serum of the observation group was observed at 24 h and 72 h after treatment. The levels of PDGF and VEGF were lower than those of the control group, and the difference was statistically significant (P＜0.05).CONCLUSION:Acetylcysteine combined with pulmonary surfactant can significantly improve the clinical efficacy of children with meconium aspiration syndrome. It may inhibit lung inflammation by regulating the expression of VEGF and PDGF, thus improving lung function in children.

Key words: fetal fecal inhalation syndrome, pulmonary surfactant, acetylcysteine, oxygenation, inflammatory factors

中图分类号:

R722.1

姜莉，李宇宁，庞立宏，张兴道，王芳. N-乙酰半胱氨酸联合肺表面活性物质对新生儿重症胎粪吸入综合征的疗效及其对胎儿炎症因子及氧合功能的影响[J]. 中国临床药理学与治疗学, 2020, 25(1): 81-86.

JIANG Li, LI Yuning, PANG Lihong, ZHANG Xingdao, WANG Fang. N-acetylcysteine combined with pulmonary surfactant alleviates neonatal severe fetus seizure syndrome through regulating fetal inflammatory factors and oxygenation[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2020, 25(1): 81-86.

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