珂立苏联合鼻塞式气道正压通气治疗早产儿呼吸窘迫综合征的临床观察

新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)是早产儿常见危重病,而肺表面活性物质(pulmonary surfactant,PS)缺乏是引起NRDS的主要原因.     

白细胞介素-6和白细胞介素-8在早期监测早产儿呼吸窘迫综合征中的意义

目的 探讨白细胞介素-6(IL-6)和白细胞介素-8(IL-8)在早期监测早产儿呼吸窘迫综合征(RDS)中的意义.方法 选择2012年7月至2013年3月本院新生儿重症监护室收治、除外先天畸形、感染、代谢性疾病、缺氧缺血性脑病、其他肺部疾病的早产儿,生后2h内取股静脉血2 ml,采用流式细胞仪测定血浆中IL-6、IL-8水平.按早产儿是否发生RDS分为RDS组和非RDS组.结果 RDS组20例,非RDS组80例,两组早产儿性别、胎龄、体重差异均无统计学意义(P＞0.05).RDS组血浆IL-6和IL-8水平均明显高于非RDS组[IL-6:(2155.3 ±200.3) pg/ml比(51.1±9.2) pg/ml,IL-8:(1625.2±154.2)pg/ml比(61.8±4.4) pg/ml],差异有统计学意义(P＜0.01).结论 在早产儿生后早期测定血浆IL-6和IL-8水平可用来探索早期RDS的发生,对RDS的早期监测和早期防治有一定的临床意义.     

鼻塞持续气道正压和肺表面活性制剂联合治疗新生儿呼吸窘迫综合征

新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)是由于肺表面活性物质(pulmonary surfactant,PS)缺乏所致,是新生儿死亡的主要原因之一.     

高频震荡通气治疗新生儿呼吸窘迫综合征

新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，NRDS）是新生儿NICU中的常见病症，病死率高。常规机械通气（conventional mechanical ventilation，CMV）是重症NRDS的主要治疗手段，高频振荡通气（high-frequency oscillatory ventilation，HFOV）是近年来出现的一种新型机械通气方式。我们自2002年以来应用HFOV治疗早产儿NRDS，现总结报道如下。     

肺表面活性物质防治早产儿呼吸窘迫综合征临床体会

新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome,NRDS）是早产儿主要的发病和死亡原因,系肺表面活性物质（pulmonary surfactant,PS）缺乏所致。针对病因给予外源性PS替代疗法对NRDS的预防和治疗效果已为国内外多数学者证实。我们自2003年起使用PS（curosurf）预防和治疗早产儿NRDS,取得满意效果,现将结果报告如下。     

新生儿呼吸窘迫综合征对降钙素原在早产儿早发感染中诊断价值的影响

目的 研究新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)对早产儿生后早期血清降钙素原(procalcitonin,PCT)表达水平及诊断价值的影响.方法 对大连医科大学附属大连市妇幼保健院新生儿科收治的199例早产儿进行回顾性研究,根据临床表现和实验室结果分为早发感染组和无早发感染组,其中无早发感染组再分为无感染NRDS组和无感染无NRDS组,比较生后12~24h外周血PCT浓度,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)评价PCT作为感染标志物的诊断价值.结果 早发感染组早产儿血清PCT浓度[10.99(5.93,19.79)μg/L]高于无感染组中NRDS组[7.16(3.46,17.36)μg/L]和无NRDS组[0.98(0.37,2.21)μg/L],差别有统计学意义(P<0.05).无感染NRDS组早产儿血清PCT浓度高于无感染无NRDS组,差别有统计学意义(P<0.05).依据早发感染组和无早发感染组血清PCT浓度绘制的ROC曲线下面积为0.800(95%可信区间为0.737~0.864);依据早发感染组和无感染NRDS组血清PCT浓度绘制的ROC曲线下面积为0.607(95%可信区间为0.504~0.710);依据早发感染组和无感染无NRDS组血清PCT浓度绘制的ROC曲线下面积为0.927(95%可信区间为0.883~0.971).结论 NRDS使早产儿生后12~24h血清PCT浓度显著升高并降低了PCT预测感染的诊断价值.在无NRDS的早产儿中PCT仍然具有较高的诊断价值.     

新生儿呼吸窘迫综合征的遗传学研究进展

新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)是新生儿期最常见的危重症,目前认为遗传因素在NRDS 发病中起着重要作用。目前与NRDS 相关的遗传性的蛋白、基因被越来越多的学者研究,本文主要综述肺表面活性物质蛋白、ATP 结合盒转运蛋白 A3基因(ABCA3)、甘露糖结合凝集素、甲状腺转录因子与NRDS的相关性。     

高频振荡通气治疗足月新生儿急性呼吸窘迫综合征

新生儿急性呼吸窘迫综合征（acute respiratory distress syndrome,ARDS）不同于早产儿肺透明膜病（hyaline membrane disease,HMD）,是新生儿危重急症之一。在国外新生儿重症监护病房中病死率较高。上世纪90年代对ARDS有了逐步深入的认识,并提出了急性肺损伤（acute lung injury．ALI）的概念,认为ALI和ARDS同属于一个病理生理过程,ARDS是ALI发展的严重阶段,是全身炎症反应综合征（SIRS）在肺部的表现。     

急性呼吸窘迫综合征相关的基础问题

从1967年Ashbaugh首次提出成人急性呼吸窘迫(acute respiratory distress in adults)概念之后,50多年间有关的探索始终没有停步,最新的定义为急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),机械通气作为针对ARDS治疗的重要措施,相关的技术研究持续进行中,近20年来,有关肺保护性通气策略的提出与实施,给ARDS机械通气治疗带来诸多新的希望和进展。2015年国际上首次给予儿童急性呼吸窘迫综合征(pediatric acute respiratory distress syndrome,PARDS)明确的定义,鉴于PARDS作为儿科临床危重症之一,其治疗仍存在诸多难点,且缺乏大规模的临床研究作为临床应用的基石,此次邀请国内儿科重症医学领域的专家,就ARDS相关呼吸力学、肺保护性通气策略中的核心问题及无创监测的最新进展等问题进行讲解,冀望能对临床医师有所帮助,推动中国的PARDS相关临床研究和技术进步。     

固尔苏治疗对新生儿呼吸窘迫综合征患儿气体交换功能的影响

新生儿呼吸窘迫综合征(Neonatal respiratory distress syndrome,NRDS)是新生儿重症监护室较常见的危重急诊.尽管随着呼吸机的普及,其治疗效果已有所改善,但重症NRDS病死率仍较高.近年来国内外根据其发病机制采用外源性肺表面活性物质(PS)替代治疗已取得了令人瞩目的疗效.本文就PS经气管插管注入治疗NRDS进行初步探讨,报告如下.     

血清高迁移率族蛋白B1与新生儿呼吸窘迫综合征的相关性研究

目的探讨血清高迁移率族蛋白B1(HMGB1)水平与新生儿呼吸窘迫综合征(NRDS)的相关性。方法选取NRDS患儿35例(观察组)及正常新生儿35例(对照组),收集两组新生儿生后12~24 h内外周静脉血,采用酶联免疫法(ELISA)检测两组新生儿血清HMGB1水平。结果 NRDS患儿血清HMGB1水平高于对照组(P0.05),重度NRDS患儿血清HMGB1水平高于轻度患儿(P0.05),死亡的NRDS患儿血清HMGB1水平高于存活患儿(P0.05)。ROC曲线分析显示预测NRDS的AUC值为0.846(95%CI:0.755~0.936),血清HMGB1 625.3 pg/m L为预测NRDS的最佳界值,预测NRDS患儿死亡风险的AUC为0.916(95%CI:0.813~1.000),血清HMGB1 772.2 pg/L为预测NRDS患儿死亡的最佳界值。结论 NRDS患儿血清HMGB1水平显著升高,血清HMGB1可较好地预测NRDS的发生及预后。     

肝素结合蛋白对儿童重症腺病毒肺炎的诊断价值

目的 探讨血清肝素结合蛋白(heparin-binding protein,HBP)对儿童重症腺病毒肺炎早期诊断的价值。方法 前瞻性纳入2019年2月至2021年8月南华大学附属长沙中心医院儿科收治的确诊为腺病毒肺炎的80例患儿为研究对象,按照重症肺炎标准分为重症腺病毒肺炎组(40例)和非重症腺病毒肺炎组(40例),比较2组入院24 h内的血清HBP、白细胞介素-6 (interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor alpha,TNF-α)、白细胞计数、血小板(platelet,PLT)、C反应蛋白等炎症指标水平的差异,并采用受试者工作特征(receiver operating characteristic,ROC)曲线分析其对重症腺病毒肺炎的早期诊断价值。结果 重症腺病毒肺炎组血清HBP水平[(46±16)ng/mL]高于非重症组[(28±13)ng/mL](P<0.05);重症腺病毒肺炎组TNF-α、IL-6、PLT水平也更高(P<0.05)。HBP对重症腺病毒肺炎的早期诊断ROC曲线下面积为0.804,取最佳截断值...     

重度胎粪吸入综合征并发急性呼吸窘迫综合征临床特征及转归分析

目的 探讨新生儿重度胎粪吸入综合征（meconium aspiration syndrome,MAS）并发急性呼吸窘迫综合征（acute?respiratory?distress syndrome,ARDS）的临床特征及转归,为临床诊治提供参考。 方法 回顾性收集2017年1月至2019年12月收治的60例重度MAS新生儿的临床资料,根据是否并发ARDS分为ARDS组（45例）与非ARDS组（15例）,比较两组患儿的临床特征及转归。 结果 60例重度MAS患儿中,45例（75%）发生ARDS。ARDS组出生后1 h动脉血气分析显示中位氧合指数显著高于非ARDS组（4.7 vs 2.1,P<0.05）;两组间入院时白细胞计数、C-反应蛋白、白细胞介素-6水平及住院期间降钙素原、C-反应蛋白、白细胞介素-6的峰值水平比较差异无统计学意义（P>0.05）。ARDS组休克发生率高于非ARDS组（84% vs 47%,P<0.05）,两组间持续性肺动脉高压、气胸、肺出血、缺氧缺血性脑病、颅内出血和弥漫性血管内凝血的发生率比较差异无统计学意义（P>0.05）。ARDS组较非ARDS组中位机械通气时间更长（53 h vs 3 h,P<0.05）。ARDS组治愈出院43例（96%）,死亡2例（4%）;非ARDS组治愈出院15例（100%）。 结论 重度MAS并发ARDS患儿呼吸窘迫出现早,机械通气时间长,休克发生率更高;建议在管理重度MAS患儿过程中密切监测氧合指数,及时诊断及治疗ARDS,同时密切评估组织灌注,积极防治休克。 引用格式:     

肠道局部组织氧饱和度和C-反应蛋白在诊断早产儿坏死性小肠结肠炎中的价值

目的 探讨肠道局部组织氧饱和度(regional oxygen saturation,rSO₂)和C-反应蛋白(C-reactive protein,CRP)在早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)诊断中的临床价值。方法 采用前瞻性观察性方法,选取2020年10月—2021年12月安徽医科大学附属省儿童医院住院的早产儿为研究对象,其中NEC组22例,非NEC组35例。NEC组在NEC确诊后24 h内监测肠道r SO₂,并于抗感染治疗前检测血清CRP水平;非NEC组对应时间点进行肠道rSO₂监测和血清CRP检测。比较2组肠道rSO₂和血清CRP水平的差异,并采用受试者工作特征曲线分析肠道rSO₂、血清CRP单独及二者联合诊断早产儿NEC的价值。结果 NEC组的肠道rSO₂低于非NEC组(P<0.05),血清CRP水平高于非NEC组(P<0.05)。受试者工作特征曲线分析显示：肠道rSO₂     

IL-6和IL-8在诊断新生儿败血症中的价值研究

目的探讨白细胞介素-6(IL-6)、IL-8在新生儿败血症诊断中的临床价值。方法采用前瞻性研究设计,选取2014年8月至2015年2月患感染性疾病的新生儿共140例(败血症组49例,局部感染组91例)为研究对象,非感染性疾病的新生儿61例作为对照组,比较各组治疗前及治疗3 d后血清中IL-6和IL-8水平的差异,分析各指标诊断新生儿败血症的价值。结果治疗前败血症组IL-6、IL-8水平均高于局部感染组和对照组,IL-6和IL-8在局部感染组中水平均高于对照组(P0.05);治疗3 d后,败血症组IL-6水平均高于局部感染组和对照组,局部感染组IL-6水平高于对照组(P0.05),IL-8在各组间差异无统计学意义(P0.05)。治疗前ROC曲线分析显示:当IL-6取32 pg/m L时,敏感度、特异度和准确性分别为87.8%、79.6%、81.6%;当IL-8取54 pg/m L时,敏感度、特异度和准确性分别为77.6%、63.8%、67.2%;IL-6+IL-8联合诊断时,敏感度、特异度和准确性分别为71.4%、86.2%、82.6%。结论 IL-6、IL-8参与炎症反应,且两者水平与感染严重程度相关,IL-6诊断新生儿败血症的价值高于IL-8,且两者联合应用可提高新生儿败血症诊断的准确性。     

Passive compliance of total respiratory system in preterm newborn infants with respiratory distress syndrome

The passive compliance of the total respiratory system (CRS) was measured by the occlusion technique in 34 preterm newborn infants with respiratory distress syndrome. Gestational age ranged from 27 to 33 weeks. Preterm newborn infants were divided into four groups on the basis of clinical criteria. Group 1 consisted of 10 infants tested during the first postnatal days (1 to 3 days) while acutely ill and requiring ventilation and oxygen therapy. After the acute phase of respiratory distress syndrome, two groups were tested: group 2 consisted of nine infants (5 to 22 days of age) who no longer required ventilation, and group 3 consisted of six infants (7 to 28 days of age) who subsequently had bronchopulmonary dysplasia. Group 4 consisted of nine infants older than 1 month of age with confirmed bronchopulmonary dysplasia. Group 1 had significantly lower CRS and CRS normalized for body weight (CRS/BW) than group 2 had (P less than 0.001). In groups 3 and 4 CRS was significantly lower than in group 2 (P less than 0.001), as was CRS/BW (P less than 0.001). There was no significant difference in CRS and CRS/BW values between groups 3 and 4. This cross-sectional study in preterm infants with respiratory distress syndrome suggests that CRS may have predictive value in regard to development of bronchopulmonary dysplasia after the acute phase of respiratory distress syndrome.     

Umbilical cord levels of interleukin-1 receptor antagonist and neonatal outcome

BACKGROUND: Previous studies indicate that there may be infant gender differences in cytokine expression associated with differences in neonatal morbidity. OBJECTIVE: We tested the hypothesis that umbilical cord interleukin-1 receptor antagonist (IL-1ra) correlates with infant gender and neonatal outcome in preterm infants. STUDY DESIGN: IL-1ra was measured in cord blood taken from 58 preterm infants (33 males, 25 females) with gestational age less than 32 weeks. Receiver operating characteristics (ROC) curve were used for identifying IL-1ra values with high sensitivity and specificity for neonatal morbidity and adverse outcome, i.e., death or survival with severe intraventricular hemorrhage or periventricular leukomalacia. RESULTS: In the female infants, but not the male infants, cord IL-1ra values correlated with postnatal depression, expressed as Apgar scores at 1 min (correlation coefficient, r(s); p value: -0.542; 0.005), 5 min (-0.571; 0.018), and 10 min (-0.442; 0.035); and postnatal age at intubation (-0.799; 0.001). The ROC area under the curve (AUC) was 0.735 for adverse outcome (p=0.013), and 0.683 for bronchopulmonary dysplasia (p=0.021) when all infants were included. However, there was a significant gender difference in the ROC curve for adverse outcome (p=0.026), with AUC 0.640 (p=0.240) in males and AUC 0.929 (p=0.008) in females. Above a chosen cutoff at 13,500 ng/l for IL-1ra cord the sensitivity and specificity for predicting adverse outcome was 100 and 81%, respectively in females versus 50 and 84% in males. CONCLUSION: Increased levels of cord IL-1ra levels are associated with neonatal morbidity and adverse outcome in preterm infants. Comparable levels of IL-1ra have different predictive value depending on infant gender.     

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??Objective To investigate the different clinical characteristics of neonatal respiratory distress syndrome??NRDS?? in infants of various gestational ages and to provide a new basis for clinical treatment. Methods A total of 80 cases of NRDS infants in the First Affiliated Hospital of Harbin Medical University from March 2012 to March 2014 were divided into two groups according to gestational age: early preterm infants group??< 34 weeks??42 cases, M group????and nearly full-term group??≥ 34 weeks??38 cases, N group??.Lung surface active substances (PS) replacement and auxiliary ventilation were used, and the general situation??risk factors??treatment condition??prognosis and complications in each group were analyzed. Results The morbidity of NRDS in the male was higher than in the female. The onset time of M group was earlier than N group. In M group it was due to the fact that glucocorticoid was not used and premature birth . In N group it was due to caesarean section. The higher incidence of NRDS in M group was due to premature rupture of membranes and placental abnormality. The lower incidence of NRDS in M group was due to pregnancy hypertension, diabetes, intrauterine distress and abnormal umbilical cord . The PS use time in M group was less than N group. The secondary utilization rate in M group was higher than the N group. The distress degree of M group was higher, and assisted ventilation time and complications were more, compared to N group. Conclusion There are different clinical characteristics of NRDS in infants of various gestational ages. Correct guidance should be given during pregnancy and childbirth and appropriate treatment should be chosen.     

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??Objective To investigate the predictive value of lipopolysaccharide binding protein ??LBP?? in early diagnosis of preterm infection with premature rupture of membrane??PROM??. Methods Totally 93 preterm infants with PROM were enrolled in this study?? and were divided into infection group ??45 cases?? and non-infection group ??48 cases?? according to the discharge diagnosis. Their serum LBP levels were detected within 24 hours after birth. High-sensitivity C-reactive protein ??hs-CRP???? procalcitonin ??PCT?? and interleukin-6 ??IL-6?? levels were compared with LBP. Receiver operator characteristic curve ??ROC?? was drawn and the area under the curve ??AUC?? was calculated. Each parameter was evaluated for the diagnosis of early-onset infection in preterm infants with PROM. In addition?? according to the severity of the disease infection group was further divided into severe infection group??21 cases?? and general infection group??24 cases??. LBP levels were detected in two groups of premature infants to assess the value of LBP in the diagnosis of premature infants with premature rupture of membranes. Results The serum levels of IL-6?? PCT and LBP in the infection group were significantly higher than those in the non-infection group. There was no significant difference on serum levels of hs-CRP between the two groups. The level of LBP in the severe infection group was higher than that in the general infection group?? and the difference between the two groups was statistically significant. The AUC of ROC for LBP ??0.974?? in early-onset bacterial infection of preterm infants with PROM was the highest?? PCT ??0.694?? second?? IL- 6 ??0.588?? third?? and hs-CRP ??0.478?? was the lowest. Conclusion Serum level of LBP is superior to hs-CRP and PCT in the diagnosis of early-onset bacterial infection in preterm infants with PROM. LBP can be used as a useful index for the early diagnosis of bacterial infection in preterm infants with PROM. LBP levels can evaluate the severity of premature premature infection in preterm premature rupture of membranes.     

新型鼻塞持续气道正压与肺表面活性物质治疗新生儿呼吸窘迫综合征疗效观察

目的　探讨新型鼻塞持续气道正压通气 (NCPAP)与肺表面活性物质 (PS)联合应用治疗新生儿呼吸窘迫综合征 (NRDS)的疗效及临床价值。方法　对 2 3例NRDS患儿进行NCPAP通气同时给予PS治疗 ,观察治疗前后血气、X线胸片和临床效果。结果　与用药前相比 ,用药后 0 5h ,PaO2 和a/APO2 即明显升高。至 6、12、2 4和 72h ,PaO2 和a/APO2 仍高于用药前水平 ,有显著性差异 (P均 <0 0 1)。用药后 6h ,PaCO2 开始下降 ,6、12、2 4和 72h ,PaCO2 明显下降 ,有显著性差异 (P均 <0 0 1)。用药后 1h ,呼吸窘迫症状消失 9例 (39 1% ) ;明显减轻 14例 (6 0 9% )。 2 4h后 ,X胸片显示肺野透明度明显改善 2 2例 (95 7% )。 2 3例中治愈 2 2例 ,治愈率 95 7%。 1例改为机械通气。结论　NCPAP与PS联合治疗NRDS疗效显著 ,能快速有效地改善NRDS的肺换气和通气功能 ,可节省PS及减少机械通气率