| BackgroundMeconium aspiration syndrome (Meconium Aspiration Syndrome, MAS) is one of the major diseases causing neonatal respiratory failure and death, a prospective multi-center clinical report in domestic displayed MAS caused respiratory failure accounted for 9.5%, the mortality rate was 7% - 15.2% and an epidemiological study abroad showed the mortality rate was 3% - 12%.Currently MAS pathogenesis is not clear. Studies have shown that lung damage after meconium aspiration is due to lung primarily cytokine imbalance, animal studies show that also may be associated with hypoxia, endothelial cell dysfunction, infection and so on. MAS has many treatments.but if concurrent sustained hypoxemia and persistent pulmonary hypertension (persistent pulmonary hypertension, PPHN),conventional treatment is poor and mortality rate is still high. How to reduce the mortality of severe MAS is still a serious problem.ObjectiveMonitor oxygenation, pulmonary artery pressure, length of hospital stay, duration of mechanical ventilation, oxygen supply and mortality of MAS children with inhaled nitric oxide therapy to evaluate its efficacy;Detect tumor necrosis factor a(TNF-a), interleukin-10 (IL-10) level to understand the effect of inhaled nitric oxide on expression of inflammatory cytokines in the lungs of MAS children.Methods1.102 children (91 full-term infants,11postterm infants) with severe MAS treated in Zhumadian Central Hospital neonatology during January 2012 to April 2014 were selected,birth weight was between 2.5kg-4.0kg, were combined with type Ⅱ respiratory failure that need mechanical ventilation to maintain pressure of oxygen and carbon dioxide partial pressure,or pulmonary hypertension;the standard of diagnosis and indication reference on "practical Neonatology".Exclude the children who with serious congenital malformations and congenital heart disease. All patients were treated with mechanical ventilation of CMVorSIMV ventilation mode. The MAS children were firstly categorized into two groups:the NO group and the conventional treatment group.The control group was comprised of 50 children who were born without disease the in the same time period.2. The NO group consisted of 52 children (33males,19females),who give the treatment with mechanical ventilation,inhaled nitric oxide and conventional therapy.The conventional treatment group consisted of 50 children (29males,21 females),who give the treatment with mechanical ventilation and conventional therapy.Control group was comprised of 50 children (28males,22females) who were born full-term without disease in the same time period excepting intrauterine infection, fetal distress, premature rupture of the amniotic fluid and pollution, birth asphyxia, aspiration pneumonia.Each group of children in terms of age,gender,birth weight,perinatal factors differences were not statistically significant (Pa> 0.05), All work was consistent with parents and signed informed consent,and the requirement of the Hospital Ethics Committees.3.Observe and record mean airway pressure (Mean Airway Pressure, MAP) and fraction of inspired oxygen (FiO2) and other ventilator parameters of children in the NO group and the conventional treatment group.In both groups before and after treatment or mechanical ventilation Oh, 1h,12h,24h were detected pulmonary arterial pressure (Pulmonary Arterial Pressure, PAP) and collected arterial blood gas to measure arterial oxygen tension (PaO2), carbon dioxide partial pressure (PaCO2) index and to calculate oxygenation index (oxygen index, OI) and arterial / alveolar oxygen tension ratio (a/APO2); simultaneously record length of hospital stay, duration of mechanical ventilation, oxygen supply.The plasma and bronchoalveolar lavage fluid (BALF)concentration of TNF-α,IL-10 were detected with enzyme- inked immonosorbent assay (ELI SA).Using carbon and oxygen detector detected content of MHb.4.Statistical analysis was performed using SPSS 17.0 statistical software.Measurement data were tested for normal distribution and homogeneity of variance test,Each group of measurement data were expressed as mean ± standard(X±S) deviation;Differences of count data between groups were analyzed using one-way ANOVA, and Bonferroni test methods;Changes in comparative indicators used repeated measures analysis of variance design,the data were tested by spherical symmetry and normality test and were corrected using the Greenhouse-Geisser (GG) method if dissatisfied football symmetry condition.as a=0.05 said the difference was statistically significant.Results1. The ratio of OI and a/AP02 did not show significantly difference between the children with NO group and conventional treatment group before treatment (P>0.05).however,we saw the ratio of OI in children with NO group was significantly lower than those in conventional treatment group and the ratio of a/AP02 in children with NO group was significantly higher than those in conventional treatment group after treatment(lh,12h,24h)(P<0.05). We found the ratio of 01 after In treatment was significantly lower than that of Oh and the ratio of a/APO2 significantly higher than that of Oh in NO group,this variety last until 24h.however,that difference happen until 24h in conventional treatment group.the difference was statistically significant (P<0.05).2. The rate of PAP did not show significantly difference between the children with NO group and conventional treatment group before treatment (P>0.05).however,we saw the rate of PAP in children with NO group was significantly lower than those in conventional treatment group after treatment(lh,12h,24h)(P<0.05). We found the rate of PAP after 1h treatment was significantly lower than that of Oh in NO group,this variety last until 24h.however,that difference happen until 12h in conventional treatment group.the difference was statistically significant (P<0.05).3. The serum concentration of IL-10 and TNF-a in children with NO group and conventional treatment group was significantly higher than those in control group(P<0.05). serum concentration of IL-10 and TNF-a did not show significantly difference between the children with NO group and conventional treatment group before treatment (P>0.05). However,we saw the serum and BALF concentration of TNF-a in children with NO group was significantly lower than those in conventional treatment group and the serum and BALF concentration of IL-10 in children with NO group was significantly higher than those in conventional treatment group after treatment(1h,12h,24h)(P<0.05). The serum concentration of IL-10 and TNF-a in children with NO group and conventional treatment group was still significantly higher than those in control group after treatment (P<0.05).4. The average time of utilizing iNO was (34±15) h and the length of hospital stay, duration of mechanical ventilation, oxygen supply in NO group was shorter than those in conventional treatment group.no significant difference was observed in term of mortality, pneumothorax, pulmonary hemorrhage, the incidence of intracranial hemorrhage between the children with NO group and conventional treatment group (P> 0.05).Conclusions1. Inhaled NO therapy may improve oxygenation and reduce pulmonary artery pressure for MAS children, which can shorten duration of mechanical ventilation, hospitalization time and oxygen supply.2. Lung inflammatory cytokines (TNF-a, IL-10) release is one of the main causes of lung injury in children MAS, Inhaled NO therapy can modulate the release TNF-a, IL-10 and other inflammatory cytokines, reducing lung damage.3. Inhaled of low concentration NO did not increase the risk of pulmonary hemorrhage, pneumothorax, intracranial bleeding and had no significant side effects. |
PDF Full Text Request