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Objective To investigate the significance of permissive hypercapnia( PHC) in the treat-ment of neonates with respiratory failure using synchronized nasal intermittent positive pressure ventilation. Methods A retrospective study was conducted in 47 neonates with respiratory failure admitted to our NICU during January 2015 to December 2017. The subjects were divided into PHC group ( n =27, PaCO245 ～70 mmHg,1 mmHg=0. 133 kPa) and non-permissive hypercapnia( non-PHC) group( n=20,PaCO235～45 mmHg),respectively. The blood gas indicators(PaO2,PaCO2,PaO2/FiO2) before and after non-invasive ventilation treatment were compared;Ventilator parameters of the two groups ( PIP, PEEP, PiO2 , Ti ) were compared. Duration of oxygen therapy,non-invasive ventilation time,starting time of feeding,length of hospi-tal stay,the incidence of intracranial hemorrhage,air leakage,ventilation induced lung injury,and reintubation rate were compared between the two groups. Results After treatment,the blood gas indexes of PaO2 and OI at 24h in two groups were significantly higher than those before the treatment(P<0. 05). There was no sig-nificant difference on PaO2 and OI between two groups both before and after treatment. PaCO2 was lower in non-PHC group after treatment than that before the treatment(P<0. 05),but it showed no difference in PHC group (P>0. 05). The PIP value of the ventilator parameters in PHC group[(19. 9 ± 2. 7) mmHg] was sig-nificantly lower than that in the non-PHC group[(21. 7 ± 2. 3) mmHg](P<0. 05),and there was no statisti-cally significant difference between the two groups in the other ventilator parameters(P>0. 05). Duration of oxygen therapy,starting time of feeding,the time of using noninvasive ventilation,length of hospital stay in PHC group were shorter obviously than those in non-PHC group [ ( 79. 5 ± 10. 8 ) h vs. ( 92. 7 ± 19. 1 ) h;(34.3±8.8)hvs.(47.1±10.8)h;(67.4±12.3)hvs.(97.6±17.3)h;(11.0±4.6)dvs.(14.0±3.9) d](P<0. 05). The incidences of air leakage,and intracranial hemorrhage showed no significant difference between PHC group and non-PHC group(3/27 cases vs. 4/20 cases;3/27 cases vs. 2/20 cases)(P>0. 05). There was no significant difference between the two groups in the rate of reintubation of invasive ventilation after non-invasive ventilation failure ( 2/27 cases vs. 3/20 cases, P > 0. 05 ) . The incidence of ventilator induced lung injury was significantly lower in PHC group than that in non-PHC group ( 2/27 cases vs. 7/20 cases) ( P<0. 05 ) . Conclusion The effects of treating respiratory failure were similar in PHC group and non-PHC group. However,the PHC treatment could shorten the time of oxygen therapy,non-invasive ventila-tion time and hospitalization time,reduce the incidence of lung injury associated with ventilator. The clinical efficacy of PHC was more significant.
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Objective To compare the clinical efficacy and the complications of two ventilation modes in the premature infants with neonatal respiratory distress syndrome(NRDS).Two different noninva-sive ventilation methods,synchronized nasal intermittent positive pressure ventilation(SNIPPV) and nasal continuous positive airway pressure(NCPAP) combined with Curosurf were used in the treatment of patients with NRDS.Methods A retrospective study was conducted in 46 infants with NRDS admitted to our hospi-tal during January 2016 to December 2017. The subjects were divided into SNIPPV group(n =24) and NCPAP group(n =22),respectively combined with Curosurf treatment. PaO2,PaCO2,oxygenation index (OI)(PaO2/FiO2),duration of oxygen therapy,noninvasive ventilation time,reintubation cases for the use of pulmonary surfactant,starting time of feeding,length of hospital stay,incidence of abdominal distention, intracranial hemorrhage,air leakage and other complications were compared between the two groups before and after treatment.Results After treatment,the blood gas indexes of PaO2and OI at 24 h both in the two groups were significantly higher than those before the treatment(P<0.05).After treatment,PaCO2was lower in both SNIPPV group and NCPAP group,but there was no statistical difference between the two groups(P>0.05).The OI at 24 h[(219 ± 23)mmHg,1 mmHg=0.133 kPa] was significantly higher in SNIPPV group than that in NCPAP group[(199 ± 26)mmHg](P<0.05).There was no difference in PaO2,PaCO2and OI between the two groups before treatment.Duration of oxygen therapy,starting time of feeding,the time of using noninvasive ventilation,length of hospital stay were shorter in SNIPPV group[(82.8 ± 11.7)h vs. (107.6 ± 20.3)h,(32.0 ± 8.0)h vs.(47.0 ± 7.2)h,(62.3 ± 10.8)h vs.(99.6 ± 17.1)h,(12.0 ± 3.5)d vs.(15.0 ± 3.8)d] than those in NCPAP group,the differences were statistically significant(P <0.05). Reintubation cases for the use of pulmonary surfactant and the incidence rate of abdominal distension, intracranial hemorrhage,air leakage showed no statistical significance between the two groups(P>0.05). Conclusion SNIPPV and NCPAP combined with Curosurf treatment have similar clinical effects in premature infants with NRDS. While SNIPPV can reduce the starting time of feeding,the time of using noninvasive ventilation,duration of oxygen therapy,length of hospital stay in the patients with NRDS,and the clinical effect is more significant.
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Objective To investigate the distribution of pathogenic bacteria characteristics and antimicrobial susceptibility results in children with positive urine culture specimen in order to provide some references for the clinical rational use of antimicrobial agents.Methods The pathogenic data of children in our hospital in 2017 with positive urine culture specimen were collected and statistical analyzed.Results A total of 364 strains of 23 pathogens have been isolated,which the Escherichia coli was dominant,accounting for 41.21％ (150strains).followed by Enterococcus faecium (18.41％),Klebsiella pneumoniae (14.29％) and Enterococcus faecalis (7.15％).Different pathogenic bacterias have varying degrees of drug resistance to commonly used antibiotics.The drug resistance rates of Escherichia coli to ampicillin,piperacillin,cefmenorr and cefazolin were 88.36％,85.71％,81.58％ and 81.16％.The drug resistance rates of Enterococcus faecium to ampicillin,clindamycin and penicillin G were 100％;the drug resistance rates of Klebsiella pneumoniae to ampicillin,tetracycline,cefazolin and cefuroxime axetil were 96.08％,92.31％,82.98％ and 80％;All Enterococcus faecalis detected were sensitive to qulnupristin/dalfopristin and clindamycin.Conclusion Escherichia coil,Enterococcus faecium,Klebsiella pneumoniae and Enterococcus faecalis ate common pathogens in positive urine culture of children.Clinicians should use antibiotics reasonably according to the pathogenic characteristics.
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Objective To investigate the effects of alveolar epithelial cells (AEC) on bronchopulmonary dysplasis(BPD) induced by hyperoxia in newborn rats.Methods The model of BPD induced by hyperoxia in neonatal rats was established.HE staining was used to observe the alveolar septum and alveoli development.The expression of the specific surfactant protein C (SPC) on type Ⅱ alveolar epithelial cells (AEC Ⅱ) and the expression of specific aquaporin 5 (aquaporin5 AQP5) on type Ⅰ alveolar epithelial cells (type Ⅰ alveolar epithelialcells,AECⅠ) were measured by immunohistochemistry.Results There was no significant difference of AQP5 between experimental groups and control group at 1 d,but significantly lower expression of AQP5 could be seen in experimental group1 on day3 (P ＜ 0.05).And then,the AQP5 level of lung tissue of newborn rats at 5,7,14d after experiment in groupl was significantly lower than that of in air control group (P ＜ 0.05).The expression of SPC protein had no significant difference between experimental groups and control group at 1 d,but the SPC level of lung tissue of newborn rats at 3,7,14d after experiment in group1 was significant lower than that of in air control group (P ＜ 0.05).Conclusion Hyperoxia exposure leads to the expression of SP-C and AQP5 decreased,which may be key points for the development of BPD.AECⅡ may play an important role in the repairation of alveolar epithelial cells in neonatal rats with BPD induced by hyperoxia.
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Objective To clarify the effect of iodine intake on serum thyroglobulin (Tg). Methods A 5-year prospective study was conducted in the 3 different iodine intake areas in China [Panshan (miht deficiency) ,Zhangwu (more than adequate) and Huanghua (excess)]. A total of 3 099 people with normal serum levels of Tg in 1999 were followed and 2 448 of these participants were feasible to be observed in 2004 and included in the present study. The serum levels of Tg, thyraglobulin antibody(TgAb), thyroid peroxidase antibody(TPOAb) and TSH, thyroid volume, family and personal histories of thyroid diseases were measured and inquried. The general linear model (GLM) was used to explore the determinants of Tg. Results Among the study population at baseline, serum Tg were significantly different in three areas [7.5 (4.4-13. 1) μg/L at Panshan, 6.8 (3.6-11.2)μg/L at Huanghua, 5.9 (3.2-10.7) μg/L at Zhangwu, P<0.01]. They were associated with age, sex and the rate of positive TgAb, abnormal thyroid volume, abnormal TSH and positive personal history of thyroid diseases, in order to control the effects of confounding factors, the data from 1856 subjects with thyroid-related indexes all in normal range and without personal history of thyroid diseases were analyzed to clarify the effect of iodine intake on Tg. The serum Tg among three areas were significantly different in both 1999 and 2004, they were all increased in 5 years with significant augment (△ Tg) among the three areas[3.1 (-0.2-8.0) μg/L at Panshan, 3.5 (0.5-9.0)μg/L at Huanghua vs 2. 5(0.3-6.1) μg/L at Zhangwu,P<0.01]. The GLM analysis revealed that age, Tg and TSH levels at baseline were the determinants of △Tg in addition to iodine intake. Conclusion Iodine intake is a dominant determinant of serum Tg. Age and TSH should also be considered while indicating iodine intake by serum Tg.