Effect of gamma globulin combined with nasal continuous positive airway pressure in treating severe neonatal pneumonia complicated with respiratory failure
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摘要:
目的 分析丙种球蛋白联合经鼻持续气道正压通气（NCPAP）在新生儿肺炎合并呼吸衰竭患者的临床疗效和预后。 方法 收集2015年3月~2018年3月住院的重型新生儿肺炎合并呼吸衰竭的患者100例，随机分为对照组50例和观察组50例。两组患者均给予包括抗感染等基础治疗，其中对照组采用经鼻持续气道正压通气治疗，观察组在对照组基础上联合使用丙种球蛋白，比较两组不同治疗方法的临床疗效、血气分析变化及不良反应，以及炎症因子血清C反应蛋白、肿瘤坏死因子-α、白细胞介素-1β和免疫球蛋白IgG、IgA表达变化。 结果 观察组经鼻持续气道正压通气联合丙球蛋白治疗24 h后，血气分析较对照组得到显著改善，呼吸困难缓解、心律恢复正常、肺部啰音消失的时间也短于对照组（P<0.05），观察组治疗后C反应蛋白、肿瘤坏死因子-α、白细胞介素-1β表达较于对照组降低（P<0.05），IgG、IgA和IgM表达较于对照组升高（P<0.05）。 结论 丙种球蛋白联合经鼻持续气道正压通气在治疗新生儿肺炎合并呼吸衰竭上比单用经鼻持续气道正压通气具有更好的临床治疗效果和预后，能有效改善患儿病情，缩短各项症状和体征消失时间，降低体内炎症水平，增强机体抵抗力，具有良好的临床推广和应用价值。 Abstract:Objective To detect the clinical effects of Gamma Globulin combined with nasal continuous positive airway pressure(NCPAP) in treating acute neonatal pneumonia complicated with respiratory failure. Methods We selected 100 cases of patients with severe neonatal pneumonia complicated with respiratory failure who were treated in our hospital from March 2015 to March 2018．According to the random number table method, they were randomly divided into the control group and the observation group, 50 cases in each group. Patients in 2 groups were all given comprehensive treatment including anti-infection. Additionally, the control group was given NCPAP, on basis of which the observation group selected Gamma Globulin to treat. The clinical manifestations before and after treatment, two groups blood gas analysis, C-reactive protein, tumor necrosis factor-α, interleukin-1β immunoglobulin levels before and after treatment and complications of two groups were compared. Results After the observation group was treated by NCPAP and Gamma Globulin for 24 h, the blood gas analysis index of the observation group after 24 h was significantly improved than that of control group (P <0.05) . The relieving time of dyspnea, heart rate recovery to normal and the time of the disappearing of rales of lungs were significantly lower than that of control group ( P<0.05). The expressions of C-reactive protein, tumor necrosis factor-α, interleukin -1β were lower than control group (P<0.05). Serum IgG, IgA and IgM levels were significantly increased than that of the control group (P<0.05). Conclusion It has distinct clinical effect to apply NCPAP with Gamma Globulin in the treatment of acute neonatal pneumonia complicated with respiratory failure. It can effectively improve neonatal condition, shorten the symptoms and signs of disappearance time, reduce the level of inflammatory cytokines, improve immunity. -
Key words:
- newborn infant /
- pneumonia /
- continuous positive airway pressure /
- gamma globulin /
- respiratory failure /
- effect
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表 1 两组患儿治疗前后血气分析比较（Mean±SD, n=50）
分组 PaO2（kPa） PaCO2（kPa） HCO3-（mmol/L） 治疗前 治疗24 h后 治疗前 治疗24 h后 治疗前 治疗24 h后 观察组 6.09±0.50 7.91±0.88 6.74±0.70 6.59±0.73 15.15±1.91 21.29±3.99 对照组 6.01±0.60 6.91±0.97 6.78±0.60 7.48±0.72 14.96±2.15 18.91±3.57 t 0.794 5.423 0.292 6.089 0.453 3.134 P 0.429 0.000 0.771 0.000 0.651 0.002 
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表 2 两组患儿治疗前临床症状缓解情况比较（Mean±SD, n=50）
分组 呼吸困难缓解时间（h） 心率恢复正常时间（h） 肺部啰音消失时间（h） 住院时间（d） 观察组 28.94±6.48 26.62±5.62 34.98±4.36 8.86±1.86 对照组 39.10±8.54 35.28±8.47 45.58±7.27 13.42±2.51 t 6.704 6.025 8.837 10.322 P 0.000 0.000 0.000 0.000
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表 3 两组患儿治疗前后炎症因子比较（Mean±SD, n=50）
分组 C反应蛋白（mg/L） 肿瘤坏死因子-α（ug/L） 白细胞介素-1β（ng/L） 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 32.58±7.35 2.26±2.09 13.62±5.93 2.06±1.98 70.96±11.54 19.12±8.43 对照组 33.44±5.60 7.30±5.10 15.66±5.51 7.44±4.04 68.60±10.91 33.39±8.17 t 0.641 6.473 1.782 8.466 1.050 8.596 P 0.523 0.000 0.078 0.000 0.296 0.000
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表 4 两组患儿治疗前后IgG、IgA、IgM比较（g/L，Mean±SD, n=50）
分组 IgG IgA IgM 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 观察组 6.22±0.76 9.82±2.05 0.60±0.07 1.06±0.43 0.60±0.06 1.11±0.38 对照组 6.09±0.56 6.27±0.80 0.61±0.06 0.65±0.06 0.61±0.07 0.65±0.07 t 0.998 11.416 1.020 6.696 0.477 8.274 P 0.321 0.000 0.310 0.001 0.635 0.001
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