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本文动态监测新生儿急性肺损伤(ALI)患儿血清肺表面活性蛋白A(SP-A)水平变化,并探讨其临床意义。选择符合ALI诊断标准且机械通气的患儿20例,于入组和出组时(即脱机或恢复期及退院或死亡前)抽取股静脉血,病情有明显变化时反复抽血,共收集标本70例次。计算PaO_2/FiO_2值及TPV/RVET值。对照组12例同期留取血清,用免疫印迹法测定SP-A浓度。ALI患儿入组时血清SP-A水平显著高于对照组(P<0.001);7例死于ALI患儿出组时血清SP-A明显高于11例存活患儿及其入组时测定值(P<0.005和P<0.05),而11例存活患儿出组时SP-A水平明显低于其入组时测定值(P<0.05)。整个观察期间ALI患儿血清SP-A水平与其相应的PaO_2/FiO_2和TPV/RVET比值呈负相关(P均<0.001)。结论:ALI新生儿血清SP-A水平与肺损伤的严重程度密切相关,动态监测患儿血中SP-A水平有利于判断病情及预后。
This article dynamically monitors changes in serum levels of pulmonary surfactant protein A (SP-A) in neonates with acute lung injury (ALI) and explores its clinical significance. Twenty children with ALI diagnostic criteria and mechanical ventilation were enrolled and femoral venous blood was withdrawn at enrollment and extubation (ie, offline or convalescent and before retirement or death). Blood samples were collected repeatedly Sample 70 times. PaO_2 / FiO_2 values and TPV / RVET values were calculated. In the control group, serum samples were collected from 12 cases at the same time, and the concentration of SP-A was determined by immunoblotting. Serum SP-A levels in children with ALI were significantly higher than those in the control group (P <0.001). Serum SP-A levels in 7 children with ALI were significantly higher than those in 11 children surviving (P <0.005 and P <0.05). However, the level of SP-A in 11 surviving children was significantly lower than that of the control group (P <0.05). The serum level of SP-A in children with ALI during the whole observation period was negatively correlated with the corresponding ratio of PaO_2 / FiO_2 and TPV / RVET (all P <0.001). Conclusion: The level of serum SP-A in neonates with ALI is closely related to the severity of lung injury. The dynamic monitoring of SP-A level in the blood of children with ALI is helpful to judge the condition and prognosis.