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目的:探讨外周血炎症介质变化预测新生儿呼吸机相关性肺炎(VAP)发生和发展的意义。方法:选择2009年1月～2011年12月需用呼吸机治疗的148例患儿,在治疗过程中观察患儿是否发生呼吸机相关性肺炎,动态检测呼吸机治疗前和治疗后24、48、72、120 h患儿外周血炎症介质的变化,比较发生呼吸机相关性肺炎的患儿和未发生的患儿治疗前后炎症介质变化的差异。结果:148例患儿中发生呼吸机相关性肺炎72例,发生率为48.6%。呼吸机相关性肺炎发生组患儿和未发生组患儿外周血炎症介质水平在治疗前差异无统计学意义(P>0.05),两组患儿治疗后24 h血清炎性介质水平均明显低于治疗前,但发生组血清炎症介质水平在24 h后又逐渐升高,而未发生组血清炎症水平逐步降低;在72 h后对发生组患儿进行相关治疗,在120 h时血清介质水平下降,病情开始好转。结论:患儿血清炎症介质水平随着呼吸机相关性肺炎的发生而升高,可以作为监测呼吸机相关性肺炎发生与发展的指标,具有重要的临床应用价值。
Objective: To investigate the changes of peripheral blood inflammatory mediators in predicting the occurrence and development of neonatal ventilator-associated pneumonia (VAP). Methods: A total of 148 children undergoing ventilator treatment from January 2009 to December 2011 were enrolled. During the treatment, ventilator-associated pneumonia was observed in the infants, before and after treatment with ventilator 24 and 48 , 72,120 h in children with inflammatory mediators in children with changes in the incidence of ventilator-associated pneumonia in children and children without treatment before and after treatment of inflammatory mediators differences. Results: Seventy-two ventilator-associated pneumonia occurred in 148 infants with a rate of 48.6%. The level of inflammatory mediators in peripheral blood of children with ventilator-associated pneumonia and non-occurring group had no significant difference before treatment (P> 0.05), and the level of serum inflammatory mediators in children with ventilator-associated pneumonia was significantly lower at 24 hours after treatment Serum levels of inflammatory mediators increased gradually after 24 h in treatment group, but gradually decreased in the group without serum inflammation. After 72 h, relevant serum levels of serum mediators were detected at 120 h Decline, the condition began to improve. Conclusion: Serum inflammatory mediators in children with the rise of ventilator-associated pneumonia may be used as an indicator to monitor the occurrence and development of ventilator-associated pneumonia and have important clinical value.