背景:新生儿呼吸窘迫综合征(NRDS)是新生儿重症监护病房中最常见的疾病之一,婴儿发病率约为7%。此外,它是中国医院新生儿死亡的主要原因。该疾病的主要机制是缺乏表面活性剂引起的低氧血症和高碳酸血症。
目的:探讨肺表面活性物质(PS)联合无创正压通气对外周血角蛋白-14(KRT-14)和内皮素-1(ET-1)水平的影响及治疗NRDS的疗效。
方法:选取我院2019年4月至2021年7月收治的呼吸窘迫综合征新生儿137例。其中,对照组64例采用无创正压通气治疗,观察73例采用PS联合无创正压通气治疗。比较两组患者KRT-14和ET-1的表达情况。死亡,并发症,比较两组患者的PaO2、PaCO2、PaO2/FiO2血气指标。采用受试者工作特征曲线(ROC)分析确定KRT-14和ET-1在NRDS治疗中的诊断价值。
结果:观察组显效率明显高于对照组。两组新生儿死亡率和不良反应无显著性差异,如支气管发育不良,紫癜,呼吸急促.治疗后,两组患者PaO2和PaO2/FiO2水平均明显高于治疗前,而PaCO2水平明显降低。治疗后,观察组PaO2和PaO2/FiO2水平明显高于对照组,观察组PaCO2明显低于对照组。治疗后,与治疗前相比,两组的KRT-14和ET-1水平均显着降低。观察组KRT-14、ET-1水平较对照组降低。ROC曲线分析显示,KRT-14的曲线下面积(AUC)为0.791,ET-1的AUC为0.816。
结论:PS联合无创正压通气可显著提高NRDS治疗的有效性。KRT-14和ET-1水平可能具有作为治疗和诊断指标的潜力。
BACKGROUND: Neonatal respiratory distress syndrome (NRDS) is one of the most common diseases in neonatal intensive care units, with an incidence rate of about 7% among infants. Additionally, it is a leading cause of neonatal death in hospitals in China. The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant.
OBJECTIVE: To explore the effect of pulmonary surfactant (PS) combined with noninvasive positive pressure ventilation on keratin-14 (KRT-14) and endothelin-1 (ET-1) levels in peripheral blood and the effectiveness in treating NRDS.
METHODS: Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included. Of these, 64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation. The expression of KRT-14 and ET-1 in the two groups was compared. The deaths, complications, and PaO2, PaCO2, and PaO2/FiO2 blood gas indexes in the two groups were compared. Receiver operating characteristic curve (ROC) analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.
RESULTS: The observation group had a significantly higher effectiveness rate than the control group. There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions, such as bronchial dysplasia, cyanosis, and shortness of breath. After treatment, the levels of PaO2 and PaO2/FiO2 in both groups were significantly higher than before treatment, while the level of PaCO2 was significantly lower. After treatment, the observation group had significantly higher levels of PaO2 and PaO2/FiO2 than the control group, while PaCO2 was notably lower in the observation group. After treatment, the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels. The observation group had a reduction of KRT-14 and ET-1 levels than the control group. ROC curve analysis showed that the area under the curve (AUC) of KRT-14 was 0.791, and the AUC of ET-1 was 0.816.
CONCLUSIONS: Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy. KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.