Clinical Analysis And Early Monitoring Of Serum Cytokines Combined With Surfaceproteins In Full Term Infants With Respiratory Failure

Neonatal respiratory failure(NRF)is a common critically ill disease in the neonatal intensive care unit(NICU),which can be caused by a variety of primary diseases,and often accompanied by acute lung injury.It is the most common cause of death and disability in the newborn,with the characteristics of high incidence,high mortality and high cost.Although there are clinical epidemiological investigations of NRF at home and abroad,there is little research on the status quo of in respiratory failure full term infants treated with mechanical ventilation,and relevant clinical studies are needed to conduct to summarize clinical experience.In addition,it is generally believed that inflammatory cytokines mediate the pathogenesis of acute lung injury(ALI)/acute respiratory distress syndrome(ARDS),and the changes of pulmonary surfactant in the quality and quantity are an important pathogenesis of respiratory failure,what's more,respiratory failure and ALI/ARDS are closely related,whether the early serum cytokines and alveolar surface protein(SPs)levels in respiratory failure full term infants have changed,and whether have relationship between each other,therefore,which remain to be explored,this article conducted related research on the above problems.PART I Clinical analysis of full term infants with respiratory failureObjective:The research aimed to survey the current status quo of treatment on respiratory failure full term infants treated with mechanical ventilation,and summary the clinical treatment experience.Methods:Collected the clinical data of 79 cases of full term infants who were hospitalized in the NICU of our hospital from June 2015 to December 2015,diagnosis of respiratory failure and treatment with mechanical ventilation,then,using the relevant statistical methods to retrospectively analysis the clinical data.Results:The sex ratio of respiratory failure full term infants treated with mechanical ventilation was 2.04:1(53/26),the common primary diseases of NRF were pulmonary infection/sepsis(36.71%),asphyxia(25.32%)and meconium aspiration syndrome(13.92%).In this study,PS usage rate was 45.57%(36/79),NO usage rate was 32.91%(26/79),the incidence rate was 7.14%(79/1107),and the mortality rate was 18.99%(15/79).And the mortality rate of the NO inhaled group is higher than the ventilator group and ventilator +PS group(x2=14.753,P=0.001).Conclusion:In our hospital,the majority of respiratory failure full term with mechanical ventilation are male,the common primary diseases were pulmonary infection/sepsis,asphyxia and MAS,mechanical ventilation,supplementation of PS and NO inhalation therapy are the main means of treatment.And the popularity of PS and NO treatment can decrease mortality,but it's morbidity and mortality is still high.What's more,the NO inhalation treatment group infants was more serious.PART ? The significance of early monitoring serum cytokines combined with alveolar surface proteins(SPs)in full term infants with respiratory failureObjective:This study was designed to analyze the early changes and the relationship of cytokines and SPs in serum of respiratory failure full term with mechanical ventilation and to explore the clinical significance of early joint monitoring of both.Methods:30 cases of respiratory failure full term infants with mechanical ventilation and 30 cases of healthy full term infants were randomly selected.According to the prognosis of infants,the case group was divided into survival group and the death group.All cases' blood samples were collected at the first day of admission,and the Case group collected blood samples again at the third day of admission,using flow cytometry instrument to detect cytokine levels and enzyme-linked immunosorbent(ELISA)method to detect the serum level of SPs,then conducted the relevant statistical analysis.Results:The levels of serum IL-6,IL-10,SP-A,SP-B and SP-C at the first day of admission in the case group were significantly higher than those in the control group(t=2.498?5.213,P<0.05),and the serum levels of SP-A and IL-6 were highly correlated with the diagnosis of respiratory failure(r=0.845?0.866,P<0.05).The serum levels of IL-6 were highly positive correlated with and SP-A,SP-C levels(r=0.920?0.984,P<0.05);SP-A and SP-C levels were also highly positive correlated(r=0.955,P<0.05).The levels of serum IL-6,SP-A and SP-C,at the first day of admission,the death group were significantly higher than those in the survival group(z=-3.173?-3.172,P<0.05),at the third day of admission,the serum levels of those in the survival group were significantly lower than those in the first day(t=2.892?4.295,P<0.05),the levels of serum IL-6,SP-A and SP-C in the treatment group with NO were significantly higher than those in breathing machine treatment group and PS usage group(x2=9.077?12.751,P<0.05).Conclusion:Serum IL-6,IL-10,SP-A,SP-B and SP-C may be involved in its pathogenesis,and IL-6 and SP-A were more closely related to the occurrence of respiratory failure,which are expected to be an early reference index for the diagnosis of respiratory failure.IL-6 may cause pathogenic effects by affecting the expression of SP-A and SP-C,and there may be a mutual influence between SP-A and SP-C.The levels of serum IL-6,SP-A and SP-C had clinical guidance significance to some extent in judging the disease condition,evaluating the prognosis and the curative effect.The patients who needed NO inhalation treatment were more seriously and the mortality rate was higher than the others.