本文選題：呼吸衰竭 + 機(jī)械通氣�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：新生兒呼吸衰竭(neonatal respiratory failure,NRF)是新生兒重癥監(jiān)護(hù)室(NICU)中的常見(jiàn)危重癥,可由多種原發(fā)疾病引起,常伴有急性肺損傷,具有高發(fā)病率、高病死率和高費(fèi)用的特點(diǎn),是導(dǎo)致新生兒致死及致殘的最常見(jiàn)原因。盡管國(guó)內(nèi)外已有對(duì)NRF的臨床流行病學(xué)調(diào)查,但對(duì)呼吸衰竭需機(jī)械通氣足月兒救治現(xiàn)狀的研究極少,有待進(jìn)行相關(guān)臨床研究,以總結(jié)臨床經(jīng)驗(yàn)。另外,目前普遍認(rèn)為炎癥細(xì)胞因子介導(dǎo)了急性肺損傷(ALI)/急性呼吸窘迫綜合征(ARDS)的發(fā)病機(jī)制,肺表面活性物質(zhì)(PS)質(zhì)和量的改變是呼吸衰竭的一個(gè)重要發(fā)病環(huán)節(jié),而呼吸衰竭與ALI/ARDS關(guān)系密切,呼吸衰竭足月兒早期血清細(xì)胞因子及肺泡表面活性蛋白(SPs)水平有無(wú)改變,兩者之間有無(wú)相互關(guān)系,尚待探討,本文針對(duì)以上問(wèn)題進(jìn)行了相關(guān)研究。第一部分呼吸衰竭足月兒的臨床分析目的:了解呼吸衰竭需機(jī)械通氣足月兒目前的救治現(xiàn)狀,總結(jié)臨床治療經(jīng)驗(yàn)。方法:收集2015年6月至2015年12月在我院足月兒NICU住院治療的79例呼吸衰竭需機(jī)械通氣足月新生兒的臨床資料,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:我院呼吸衰竭需機(jī)械通氣足月兒男/女性別比為2.04:1(53/26),原發(fā)疾病以肺部感染/敗血癥(36.71%)、窒息(25.32%)和胎糞吸入綜合征(MAS,13.92%)較常見(jiàn)。79例患兒的PS使用率為45.57%(36/79),NO使用率為32.91%(26/79),發(fā)病率為7.14%(79/1107),病死率為18.99%(15/79),NO吸入組病死率高于呼吸機(jī)組及呼吸機(jī)+PS組(x2=14.753,P=0.001)。結(jié)論:我院呼吸衰竭足月兒中男性居多,肺部感染/敗血癥、室息及MAS為主要原發(fā)疾病,機(jī)械通氣、補(bǔ)充PS及NO吸入是主要救治手段,PS及NO治療的普及可降低病死率,但其發(fā)病率及病死率仍然較高,且需NO吸入治療組患兒的病情更重。第二部分呼吸衰竭足月兒早期血清細(xì)胞因子、SPs監(jiān)測(cè)及意義目的:本研究旨在通過(guò)分析呼吸衰竭足月兒早期血清細(xì)胞因子、SPs的水平及相互關(guān)系,探討兩者早期監(jiān)測(cè)的臨床意義。方法:隨機(jī)選取2016年10月至2016年12月我院30例呼吸衰竭需機(jī)械通氣足月兒為病例組,30例“健康”足月兒為對(duì)照組,根據(jù)預(yù)后再將病例組分為存活組及死亡組,所有病例入院第一天采血,病例組入院第三天再次采血,用流式細(xì)胞儀檢測(cè)細(xì)胞因子,酶聯(lián)免疫吸附法(ELISA法)檢測(cè)血清SPs,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:病例組IL-6、IL-10、SP-A、SP-B及SP-C水平顯著高于對(duì)照組(t=2.498～5.213,P0.05),且IL-6、SP-A與呼吸衰竭診斷間高度相關(guān)(r=0.845～0.866,P0.05)。血清IL-6與SP-A、SP-C水平呈高度正相關(guān)(r=0.920～0.984,P0.05),SP-A及SP-C水平亦呈高度正相關(guān)(r=0.955,P0.05)。IL-6、SP-A、SP-C水平,在入院第一天死亡組顯著高于存活組(z=-3.173～-3.172,P0.05),存活組入院第三天顯著低于第一天(t=2.892～4.295,P0.05),需NO吸入治療組水平顯著高于需PS治療組及單純呼吸機(jī)治療組(X2=9.077～12.751,P0.05)。結(jié)論:血清IL-6、IL-10、SP-A、SP-B、SP-C可能參與其發(fā)病過(guò)程,且IL-6及SP-A與呼吸衰竭的發(fā)生關(guān)系更密切,有望成為呼吸衰竭診斷的早期參考指標(biāo)。IL-6可能通過(guò)影響SP-A、SP-C的表達(dá)產(chǎn)生致病作用,且SP-A及SP-C之間可能也存在互相影響。血清IL-6、SP-A及SP-C水平對(duì)判斷病情、了解療效、評(píng)估預(yù)后有一定程度的臨床指導(dǎo)意義,需NO吸入治療的呼吸衰竭患兒病情更重,病死率更高。
[Abstract]:Neonatal respiratory failure (neonatal respiratory failure, NRF) is a common critical disease in neonatal intensive care unit (NICU), which can be caused by a variety of primary diseases, often accompanied by acute lung injury, with high morbidity, high mortality and high cost, which is the most common cause of death and disability of newborn infants. Although NRF at home and abroad However, there are few studies on the status of the treatment of respiratory failure with mechanical ventilation, but the clinical study is needed to summarize the clinical experience. In addition, it is widely believed that inflammatory cytokines mediate the pathogenesis of acute lung injury (ALI) / acute respiratory distress syndrome (ARDS) and pulmonary surfactant (PS). The change of quality and quantity is an important link of respiratory failure, and respiratory failure is closely related to ALI/ARDS. There is no change in the level of serum cytokines and alveolar surface active protein (SPs) in the early stage of respiratory failure, and there is no relationship between them. The first part of this paper is related to the above problems. Clinical analysis of full moon children with respiratory failure: to understand the current treatment status of respiratory failure and to summarize the experience of clinical treatment. Methods: to collect the clinical data of 79 cases of respiratory failure in the foot month of NICU in our hospital from June 2015 to December 2015. The results were statistically analyzed. Respiratory failure in our hospital requires mechanical ventilation for men / women with 2.04:1 (53/26), primary diseases with pulmonary infection / septicemia (36.71%), asphyxia (25.32%) and meconium aspiration syndrome (MAS, 13.92%) more than common.79 cases, PS use rate is 45.57% (36/79), NO use rate is 32.91% (26/79), incidence rate is 7.14% (79/1107), and mortality is 18.99% (1) 5/79), the mortality rate of NO inhalation group was higher than that of the respiratory and ventilator +PS group (x2=14.753, P=0.001). Conclusion: the majority of men in the foot month of respiratory failure in our hospital, pulmonary infection / sepsis, ventricular interest and MAS are the main primary diseases, mechanical ventilation, supplemental PS and NO inhalation are the main means of rescue, and the prevalence of PS and NO treatment can reduce the mortality, but the incidence of the disease is reduced. And the mortality rate is still higher, and the condition of NO inhalation treatment group is more serious. Second part of the early serum cytokines, SPs monitoring and significance aim: the purpose of this study is to analyze the level and relationship of serum cytokines and SPs in the early stage of respiratory failure, and to explore the clinical significance of early monitoring. Method: 30 cases of respiratory failure in our hospital from October 2016 to December 2016 were randomly selected as the case group of mechanical ventilation foot months. 30 cases of "healthy" foot moon were used as the control group. According to the prognosis, the case group was divided into the survival group and the death group. All the cases were collected on the first day of admission to the hospital. The case group was collected again for third days in the hospital, and the cells were detected by flow cytometry. The serum SPs was detected by enzyme linked immunosorbent assay (ELISA). The results showed that the level of IL-6, IL-10, SP-A, SP-B and SP-C in the case group was significantly higher than that of the control group (t=2.498 ~ 5.213, P0.05), and IL-6, SP-A was highly correlated with the diagnosis of respiratory failure (r=0.845 ~ 0.866). 0.984, P0.05), the level of SP-A and SP-C also showed high positive correlation (r=0.955, P0.05).IL-6, SP-A, SP-C level. In the first day of admission, the death group was significantly higher than the survival group (z=-3.173 ~ -3.172, P0.05). The survival group was significantly lower than the first day (t=2.892 ~ 4.295), and the level of inhalation treatment group was significantly higher than that of the treatment group and simple breathing. Conclusion: serum IL-6, IL-10, SP-A, SP-B, SP-C may be involved in the pathogenesis of IL-6, IL-10, SP-A, SP-B, SP-C, and IL-6 and SP-A are more closely related to the occurrence of respiratory failure. It is expected to be an early reference index for the diagnosis of respiratory failure..IL-6 may be influenced by SP-A, the expression of SP-C may be pathogenic. The level of serum IL-6, SP-A and SP-C has a certain clinical guiding significance in judging the condition, understanding the curative effect and evaluating the prognosis. The patients with respiratory failure with NO inhalation are more serious and more fatality.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R722.1

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