| ObjectiveNeonatal mechanical ventilation-related lung injury is a common complication of neonatal mechanical ventilation(MV).Common lung injuries include barotrauma,volutrauma,atelectrauma,and biotrauma.Severe cases can lead to acute respiratory distress syndrome(ARDS),bronchopulmonary dysplasia(BPD)and other consequences.Probiotics are a kind of microorganisms that are beneficial to the host and mutually beneficial to the host.The beneficial functions of probiotics to human body include stabilizing and maintaining the barrier function of gastrointestinal tract,reducing colonization of pathogenic bacteria in intestinal mucosa infection,maintaining the balance of host digestive tract microorganisms,regulating local and systemic immune reactions,inhibiting inflammatory immune reactions,promoting nutrition,etc.At present,it has been widely used in neonatal digestive diseases.Serum 16(Clara cell secretory protein 16,CC16)is a small molecule protein secreted by respiratory epithelial Clara cells to protect distal airways.It has the effects of regulating immunity and anti-inflammation,and is a marker of permeability and integrity of alveolar epithelial cells.Monitoring of lung function-related parameters can distinguish neonatal lung function.Blood gas analysis and tidal breathing lung function detection methods are commonly used clinically,which have the advantages of high accuracy and repeatable detection.The purpose of this study is to investigate the effect of probiotics on serum Clara cell secretory protein 16,lung function and clinical outcome of neonates undergoing mechanical ventilation through the study of the application of probiotics in neonatal mechanical ventilation.Methods1.From January 2018 to January 2020,60 children who were admitted to the neonatal intensive care unit of Subei People's Hospital and used mechanical ventilation within one week after birth were selected as the research objects and divided into probiotic intervention group(29 cases)and non-probiotic intervention group(31 cases)according to the random number table method.2.Two groups of children respectively collected 2mL venous blood samples at 4 time points of 1 hour before,12 hours,72 hours after and 1 hour before withdrawal of the machine.After collecting blood,centrifuged at 3000 r/min for 10 minutes.After centrifugation,the upper serum was sucked by suction tube and stored in a refrigerator at-20?for batch detection.enzyme linked immunosorbent assay(ELISA)method was used for determination in strict accordance with the standard operating procedures of the manual.3.Blood samples were collected from radial artery at 4 corresponding time points(1 hour before the machine was put into operation,12 hours after the machine was put into operation,72 hours after the machine was put into operation and 1 hour before the machine was withdrawn)to detect arterial blood gas,and calculate arterial partial oxygen pressure/inhaled oxygen concentration ratio(P/F)and arterial/alveolar oxygen partial pressure ratio(PaO2/PAO2).The calculation formula is:P/F=PaO2/FiO2(mmHg);PaO2/PAO2=PaO2/(713×FiO2-PaCO2/0.8).4.The pulmonary function of the two groups of children was tested before discharge.The observation indexes included respiratory frequency(RR),tidal volume(VT),peak-to-peak time ratio(TPIEF/TE),peak-to-peak volume ratio(VPEF/VE),and expiratory flow rate at 25%,50%,75%tidal volume(TEF25,TEF50,TEF75).Each child was tested 5 times in succession,20 tidal breaths were recorded each time,and the average value was taken.meanwhile,the flow rate-volume loop was depicted.5.Statistics of mechanical ventilation time,oxygen therapy time,hospitalization time,pneumothorax and incidence of BPD in two groups of children.6.SPSS 22.0 statistical software was used for data statistical analysis.All continuous variables were tested for normal distribution and variance homogeneity first.Continuous variables are expressed by mean standard deviation(x±s),differences between groups are tested by Student's t test,and comparisons within groups are tested by paired samples t test.Chi-square test was used for counting data.There was statistical significance when the P value was less than 0.05 in bilateral tests.Results1.60 cases of children,probiotic intervention group 29 cases,non-probiotic intervention group 31 cases,two groups of newborns in terms of gender,gestational age,birth weight,delivery methods,height and other differences were not statistically significant(P>0.05),comparable.2.There was no significant difference in serum CC16 between the two groups one hour before the operation(P>0.05).The level of serum CC16 in non-probiotic intervention group was slightly higher than that in probiotic intervention group 12 hours after operation,but the difference was not statistically significant(P>0.05).The serum CC16 level of non-probiotic intervention group was significantly higher than that of probiotic intervention group 72 hours after operation,the difference was statistically significant(P<0.05).The serum CC16 level in the non-probiotic intervention group was significantly lower than that in the probiotic intervention group before weaning,and the difference was statistically significant(P<0.05).The serum CC16 level of the two groups was slightly higher at 12 hours after operation than at 1 hour before operation,but the difference was not statistically significant(P>0.05).The serum CC16 level of the two groups of children at 72 hours after operation was significantly higher than that at 12 hours after operation,the difference was statistically significant(P<0.05).The serum CC16 level of the two groups was significantly lower one hour before weaning than 72 hours after weaning,and the difference was statistically significant(P<0.01).3.PaO2,PaCO2,P/F and PaO2/PAO2 of the two groups of children were kept at a good level.PaO2,P/F and PaO2/PAO2 showed an upward trend with the prolongation of treatment time,while PaO2 showed a downward trend.There was no significant difference in PaO2,PaCO2,P/F,PaO2/PAO2 between the two groups(P>0.05).PaO2,P/F,PaO2/PAO2 in probiotic intervention group were significantly higher than those in non-probiotic intervention group(P<0.05),while PaCO2 was lower than that in non-probiotic intervention group(P<0.05).PaO2,P/F,PaO2/PAO2 in both groups increased 1 hour before weaning compared with 72 hours after weaning(P<0.05),while PaCO2 decreased(P<0.05).PaO2,P/F,PaO2/PAO2 in probiotic intervention group were significantly higher than those in non-probiotic intervention group(P<0.05)and PaCO2 was lower than those in non-probiotic intervention group(P<0.05)one hour before weaning.4.The respiratory frequency,tidal volume,peak-to-peak time ratio,peak-to-peak volume ratio,75%,50%,25%tidal volume expiratory flow rate(TEF75,TEF50,TEF25)were statistically different between the two groups(P<0.05).the tidal volume,peak-to-peak time ratio,peak-to-peak volume ratio,75%,50%,25%tidal volume expiratory flow rate(TEF75,TEF50,TEF25)in probiotic intervention group were higher than those in non-probiotic intervention group(P<0.05),while the respiratory frequency was lower than that in non-probiotic intervention group(P<0.05).5.The mechanical ventilation time,oxygen therapy time and hospitalization time in probiotic intervention group were slightly shorter than those in non-probiotic intervention group,with no significant difference(P>0.05).The incidence of pneumothorax and BPD were similar between the two groups(P>0.05).Conclusions1.Mechanical ventilation may cause acute lung injury in different degrees;With the prolongation of ventilation time,the destruction of alveolar epithelial integrity becomes more and more obvious.Long-term mechanical ventilation causes airway epithelium damage,Clara cells decrease in number,and CC16 protein secretion ability decreases.2.Probiotics may prevent the destruction of alveolar epithelial cells and maintain their integrity by regulating local and systemic immune function,inhibiting inflammatory immune response,promoting nutrition and other mechanisms.3.Probiotics can increase alveolar ventilation and functional residual air volume,correct hypoxemia and promote CO2 emission from alveoli.And can better improve oxygenation,reduce lung injury,promote repair of damaged alveoli and recovery of lung function,and improve lung ventilation and air exchange functions after mechanical ventilation and lung injury.4.After preventive administration of probiotics,the clinical outcome of mechanical ventilation-related lung injury may be improved to some extent. |
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