小潮气量通气联合肺复张策略在治疗急性肺损伤患儿中的肺保护作用

目的应用小潮气量通气联合肺复张策略(RM)治疗小儿急性肺损伤(ALI),动态观察血浆肺表面活性物质相关蛋白-A(SP-A)及IL-6水平变化,并探讨其临床意义。方法前瞻性观察ALI患儿30例。分为2组,各15例,一组给予常规机械通气方式(CON组),潮气量为10～15 mL.kg-1;另一组予以小潮气量联合RM通气方式(RM组),潮气量为6～8 mL.kg-1,RM采用持续呼吸道正压通气(CPAP)方式,维持压力为2.94 kPa,每次维持30 s,每天平均进行3次,连续5 d,其他治疗均相同。分别于入组第1天,第3天,第5天留取血样,ELISA法测定其血浆SP-A及IL-6水平,比较2组结果的差异。结果入组时2组患儿IL-6水平相近,至入组第3天及第5天时,RM组IL-6水平分别降为(304.3±58.6)×10-9g.L-1和(223.0±60.6)×10-9g.L-1,同时间点CON组虽然也分别降至(374.9±105.7)×10-9g.L-1和(316.2±107.3)×10-9g.L-1,但RM组IL-6水平均显著低于CON组(Pa<0.05)。入组时2组患儿SP-A水平无差异性,入组第3天,RM组SP-A水平降至(256.0±59.4)×10-9g.L-1,而CON组为(293.5±48.6)×10-9g.L-1,二者略有不同,但差异无统计学意义;至入组第5天RM组患儿达(194.2±54.4)×10-9g.L-1,显著低于相应CON组[(252.1±71.5)×10-9g.L-1](P<0.05)。结论应用RM联合小潮气量通气治疗小儿ALI,可使血浆SP-A及IL-6水平显著下降,减轻呼吸机相关性肺损伤的程度,具有肺保护作用。

Protective Effect on Lung of Recruitment Maneuver with Low Tidal Volume in Treatment of Children with Acute Lung Injury

Objective To dynamically assess the surfactant protein A(SP-A) and interleukin-6(IL-6) concentrations in serum of children with acute lung injury(ALI) receiving recruitment maneuver(RM) with low tidal volume,and discuss its clinical significance.Me-thods A prospective physiologic study was conducted.Thirty children with ALI were assigned to conventional ventilation group(CON group) and RM with low tidal volume group(RM group),with 15 patients per group.The patients in CON group were ventilated with tidal volume of 10-15 mL·kg-1.In contrast,the ventilation strategy in RM group was 6-8 mL·kg-1 tidal volume.RM was administered continuous positive airway pressure(CPAP) maintained at 2.94 kPa for 30 seconds,once every 8 hours for 5 days.And blood samples were collected for the measurement of plasma levels of IL-6 and SP-A on the first,third and fifth day.The data were summarized,and physiologic variables were compared between the 2 groups.Results No evidence of significant change in the level of IL-6 was found at study entry.When it came to the third day and the fifth day,the concentrations of IL-6 in RM group were reduced into(304.3±58.6)×10-9 g·L-1 and(223.0±60.6)×10-9 g·L-1,which were lower than that in CON group[(374.9±105.7)×10-9 g·L-1,(316.2±107.3)×10-9 g·L-1(Pa<0.05)].In RM group,the level of SP-A was(256.0±59.4)×10-9 g·L-1 on the third day,and it decreased into(194.2±54.4)×10-9 g·L-1 on the fifth day.Compared with it,the concentration of SP-A in CON group was(293.5±48.6)×10-9 g·L-1 and(252.1±71.5)×10-9 g·L-1,respectively.Significant reduction of the concentrations of SP-A on the fifth day were observed in RM group(P<0.05).Conclusions Recruitment maneuver with low tidal volume in the treatment of children with acute lung injury can reduce the level of SP-A and IL-6 evidently,so it can alleviate the injury of the lung induced by ventilation and may be helpful to the protection of lung.