| ObjectivePremature brain injury(BIPI)refers to cerebral hemorrhage or ischemic changes caused by various pathological factors during the perinatal period,accompanied by clinical symptoms such as central apnea,convulsion,muscle tone,and primitive reflex abnormality.Early clinical symptoms are often atypical and need to rely on cranial ultrasound,cranial MRI,electroencephalogram and other diagnostic aids..Color Doppler ultrasound technology has been widely used in neonatal intensive care unit because of its advantages of simple operation,flexibility and non-invasive.Dynamic monitoring of neonatal cerebral hemodynamics can find BIPI in time.Glial fibrillary acidic protein(GFAP)is mainly distributed in astrocytes of central nervous system,participating in the formation of cytoskeleton and maintaining its tensile strength.Vascular endothelial growth factor(VEGF)can promote the formation of new blood vessels,enhance the permeability of blood-brain barrier,and repair nerve function.Both serum biological indexes can indirectly reflect the damage and degree of nerve cells.Premature infants are often complicated with respiratory distress syndrome(RDS)after birth due to immature development of important organs,and often need invasive auxiliary ventilation.While helping children to establish effective breathing,mechanical ventilation can often cause fluctuations in cerebral hemodynamics due to imperfect brain anatomy and physiological development of premature infants,which leads to an increase in the incidence of BIPI.Therefore,by studying the effects of different mechanical ventilation strategies on cerebral hemodynamics and serum GFAP and VEGF levels of premature infants with RDS,it aims to provide new ideas and theoretical basis for clinical treatment,selecting appropriate mechanical ventilation strategies,and reducing the occurrence of BIPI.Methods1.Research subjects 54 premature infants with mechanical ventilation hospitalized in our hospital from January 2019 to January 2021 were selected as the research objects,and were randomly divided into SIMV group(28 cases)and SIMV+VG group(26 cases).2.Research methods Routine treatment:After admission,all patients were treated with warm-keeping in incubator,ECG pulse oxygen monitoring,pulmonary surfactant,caffeine and intravenous nutrition.Group SIMV adopts SIMV mode,and group SIMV+VG adopts SIMV+VG mode.On the 1st,3rd and 7th day after birth,all children were examined by bedside head color Doppler ultrasound,and then reexamined once every other week until they were discharged from hospital.If there is any abnormality,the reexamination frequency can be increased,and the hemodynamic parameters of middle cerebral artery(MCA)such as systolic peak flow rate(Vs),end diastolic blood flow rate(Vd)and resistance index(RI)can be monitored.Magnetic Resonance Imaging(MRI)was performed before discharge or 40 weeks after correction of gestational age.1.5ml of venous blood was collected from all children on the 1st,3rd,and 7th day after birth,and the serum GFAP and VEGF levels were measured by double-antibody sandwich enzyme-linked immunosorbent assay(ELISA).Compare the changes of cerebral hemodynamic parameters(Vs,Vd,RI)and serum GFAP and VEGF levels between SIMV group and SIMV+VG group at different time points;at the same time,the correlation between serum GFAP and VEGF levels was analyzed;the effects of different mechanical ventilation strategies between the two groups on the clinical outcomes of preterm infants with RDS were compared.3.statistical treatment This data is analyzed by SPSS24.0 statistical software,in which the measurement data are expressed by(x±s),all continuous variables are tested for normal distribution and homogeneity of variance.T-test of independent samples was used for comparison between groups,repeated measurement variance analysis was used for comparison at different time points in the same group;the enumeration data were described by frequency and rate,and Pearson’s chi-square test or continuous calibration test was used between groups.Pearson correlation analysis was used to verify the correlation between indicators.It means statistically significant(P<0.05).Resuts1.There was no significant difference in sex,mode of delivery,gestational age and birth weight between the two groups(P>0.05).2.On the 1st day after birth,there was no significant difference in Vs,Vd and RI between SIMV group and SIMV+VG group(P>0.05).On the 3rd day after birth,Vs and Vd in SIMV group were larger than those in SIMV+VG group,and RI was smaller than that in SIMV+VG group,with statistical significance(P<0.05).On the 7th day after birth,the Vs and Vd values of SIMV group were higher than those of SIMV+VG group,and the RI values were lower than those of SIMV+VG group,but there was no significant difference(P>0.05).With the increase of age,the values of Vs,Vd and RI of premature infants in the two groups gradually increased,and the differences of Vs,Vd and RI in the1st,3rd and 7th days after birth were statistically significant(P<0.05).3.On the 1st day after birth,the serum GFAP levels of premature infants in the two groups were similar,with no statistical difference(P>0.05).On the 3rd and 7th day after birth,serum GFAP levels in SIMV group were higher than those in SIMV+VG group,and the differences were statistically significant(P<0.05).The serum GFAP levels of premature infants in the two groups were higher on the 3rd day after birth than on the 1st day,and the differences were statistically significant(P<0.05).On the 7th day after birth,it was significantly lower than that on the 1st and 3rd days(P<0.05).4.On the 1st day after birth,the serum VEGF levels of premature infants in the two groups were similar,with no statistical difference(P>0.05).On the 3rd and 7th day after birth,serum VEGF levels in SIMV group were higher than those in SIMV+VG group,and the differences were statistically significant(P<0.05).The serum VEGF levels of premature infants in the two groups were higher on the 3rd day after birth than on the 1st day,and the differences were statistically significant(P<0.05).On the 7th day after birth,it was significantly lower than that on the 1st and 3rd days(P<0.05).5.There is a positive correlation between serum GFAP and VEGF.6.The incidence of hospitalization time,mortality,retinopathy of prematurity(ROP),and bronchopulmonary dysplasia(BPD)in the SIMV group were slightly higher than those in the SIMV+VG group,6.but there was no significant difference(P>0.05).Invasive mechanical ventilation time in SIMV group was longer than that in SIMV+VG group(P<0.05).There were 18 cases with brain injury,accounting for 33.33%,and 36 cases without brain injury,accounting for 66.67%.The rate of brain injury in premature infants in SIMV group was 46.43%(13/28),and that in SIMV+VG group was 19.23%(5/26),which was significantly higher than that in SIMV+VG group(χ2=4.488,P=0.034).Conclusions1.In SIMV+VG group,due to the addition of VG mode,while ensuring the target tidal volume,it can reduce the average airway pressure and average arterial pressure,reduce the burden of cardiac circulation,and improve the cerebral hemodynamic parameters(Vs,Vd,RI)and the ability of cerebral vascular autonomic regulation.2.Serum GFAP and VEGF levels fluctuated in different degrees in SIMV and SIMV+VG groups.Both ventilation modes can lead to different degrees of brain injury.3.Serum GFAP and VEGF levels in SIMV group were higher than those in SIMV+VG group,and SIMV+VG had better brain protection than SIMV alone.4.The incidence of BIPI in the SIMV group was significantly higher than that in the SIMV+VG group(P<0.05);the hospitalization time,mortality,ROP,and BPD incidence were slightly higher than those in the SIMV+VG group(P>0.05).SIMV+VG model has better brain protection than SIMV. |
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