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目的应用小潮气量通气联合肺复张策略(RM)治疗小儿急性肺损伤(ALI),动态观察血浆肺表面活性物质相关蛋白-A(SP-A)及IL-6水平变化,并探讨其临床意义。方法前瞻性观察ALI患儿30例。分为2组,各15例,一组给予常规机械通气方式(CON组),潮气量为10～15 mL.kg-1;另一组予以小潮气量联合RM通气方式(RM组),潮气量为6～8 mL.kg-1,RM采用持续呼吸道正压通气(CPAP)方式,维持压力为2.94 kPa,每次维持30 s,每天平均进行3次,连续5 d,其他治疗均相同。分别于入组第1天,第3天,第5天留取血样,ELISA法测定其血浆SP-A及IL-6水平,比较2组结果的差异。结果入组时2组患儿IL-6水平相近,至入组第3天及第5天时,RM组IL-6水平分别降为(304.3±58.6)×10-9g.L-1和(223.0±60.6)×10-9g.L-1,同时间点CON组虽然也分别降至(374.9±105.7)×10-9g.L-1和(316.2±107.3)×10-9g.L-1,但RM组IL-6水平均显著低于CON组(Pa<0.05)。入组时2组患儿SP-A水平无差异性,入组第3天,RM组SP-A水平降至(256.0±59.4)×10-9g.L-1,而CON组为(293.5±48.6)×10-9g.L-1,二者略有不同,但差异无统计学意义;至入组第5天RM组患儿达(194.2±54.4)×10-9g.L-1,显著低于相应CON组[(252.1±71.5)×10-9g.L-1](P<0.05)。结论应用RM联合小潮气量通气治疗小儿ALI,可使血浆SP-A及IL-6水平显著下降,减轻呼吸机相关性肺损伤的程度,具有肺保护作用。
Objective To observe the changes of plasma pulmonary surfactant-associated protein-A (SP-A) and interleukin-6 (IL-6) levels in children with acute lung injury (ALI) treated with small tidal volume ventilation and pulmonary reexpansion (RM) . Methods A prospective observation of 30 children with ALI. (CON group), tidal volume was 10 ~ 15 mL.kg-1, while the other group was given low tidal volume combined with RM ventilation (RM group), tidal volume (6-8 mL.kg-1). Continuous positive airway pressure (CPAP) was used to maintain the pressure at 2.94 kPa for 30 s every time. The average daily dose was 3 times for 5 days. The other treatments were the same. Blood samples were collected on the first day, the third day and the fifth day respectively. Plasma levels of SP-A and IL-6 were measured by ELISA. The differences between the two groups were compared. Results The levels of IL-6 in the two groups were similar at the time of enrollment. At day 3 and day 5, the levels of IL-6 in the RM group were reduced to (304.3 ± 58.6) × 10-9g.L-1 and ± 60.6) × 10-9g.L-1, while the CON group decreased to (374.9 ± 105.7) × 10-9g.L-1 and (316.2 ± 107.3) × 10-9g.L-1, However, the level of IL-6 in RM group was significantly lower than that in CON group (Pa <0.05). There was no difference in the level of SP-A between the two groups. On the third day after the operation, the level of SP-A in the RM group decreased to (256.0 ± 59.4) × 10-9g.L-1, while that in the CON group was (293.5 ± 48.6) × 10-9g.L-1, but the difference was not statistically significant. On the fifth day after admission, the number of children in RM group was (194.2 ± 54.4) × 10-9g.L-1, significant Lower than the corresponding CON group [(252.1 ± 71.5) × 10-9g.L-1] (P <0.05). Conclusion The combination of RM combined with low tidal volume ventilation in children with ALI can significantly reduce the level of plasma SP-A and IL-6, reduce the degree of ventilatory-related lung injury, with lung protection.