中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2011年
6期
583-587
,共5页
钱进先%陆骏灏%陆士奇%赵益明
錢進先%陸駿灝%陸士奇%趙益明
전진선%륙준호%륙사기%조익명
创伤%肺挫伤%血管性假血友病因子%呼吸窘迫综合征%白细胞介素
創傷%肺挫傷%血管性假血友病因子%呼吸窘迫綜閤徵%白細胞介素
창상%폐좌상%혈관성가혈우병인자%호흡군박종합정%백세포개소
Trauma%Pulmonary contusion%vWF%ARDS%IL-8
目的 通过检测严重肺挫伤患者血中冯·维勒布兰德因子(vWF),白介素8在受伤后不同时点的含量,揭示其动态变化规律及其临床价值.方法 将63例严重肺挫伤患者分成ARDS组和非ARDS组、生存组和死亡组、ISS评分<20分和ISS评分≥20分组,并引入正常对照组,使用ELISA法分别检测伤后24 h内、第3天、第5天、第7天时的血浆vWF和血清IL-8水平,观察其动态规律,并进行相关因素分析.结果 严重肺挫伤患者在各时点,血浆vWF和血清IL-8均高于正常对照组.严重肺挫伤并发ARDS组血浆vWF含量各时点逐渐升高,ARDS组在第5天、第7天血浆vWF含量显著高于非ARDS组(P<0.05).血清IL-8含量在第5天达到高峰后开始下降,两组之间在各时点差异具有统计学意义(P<0.05);死亡组血浆vWF与血清IL-8含量均显著高于生存组(P<0.05);ISS评分≥20分组血浆vWF和血清IL-8水平均在第5天达到高峰后开始回落,ISS评分<20分组在第3天达到高峰后回落.血浆vWF含量与血小板计数呈正相关,与氧合指数呈负相关.血清IL-8含量与白细胞计数、ISS评分呈正相关,与氧合指数呈负相关.结论 严重肺挫伤患者血中vWF和IL-8含量呈动态变化,反映了肺损伤的程度,并可以作为严重肺挫伤后并发ARDS的预测及预后判断指标.
目的 通過檢測嚴重肺挫傷患者血中馮·維勒佈蘭德因子(vWF),白介素8在受傷後不同時點的含量,揭示其動態變化規律及其臨床價值.方法 將63例嚴重肺挫傷患者分成ARDS組和非ARDS組、生存組和死亡組、ISS評分<20分和ISS評分≥20分組,併引入正常對照組,使用ELISA法分彆檢測傷後24 h內、第3天、第5天、第7天時的血漿vWF和血清IL-8水平,觀察其動態規律,併進行相關因素分析.結果 嚴重肺挫傷患者在各時點,血漿vWF和血清IL-8均高于正常對照組.嚴重肺挫傷併髮ARDS組血漿vWF含量各時點逐漸升高,ARDS組在第5天、第7天血漿vWF含量顯著高于非ARDS組(P<0.05).血清IL-8含量在第5天達到高峰後開始下降,兩組之間在各時點差異具有統計學意義(P<0.05);死亡組血漿vWF與血清IL-8含量均顯著高于生存組(P<0.05);ISS評分≥20分組血漿vWF和血清IL-8水平均在第5天達到高峰後開始迴落,ISS評分<20分組在第3天達到高峰後迴落.血漿vWF含量與血小闆計數呈正相關,與氧閤指數呈負相關.血清IL-8含量與白細胞計數、ISS評分呈正相關,與氧閤指數呈負相關.結論 嚴重肺挫傷患者血中vWF和IL-8含量呈動態變化,反映瞭肺損傷的程度,併可以作為嚴重肺挫傷後併髮ARDS的預測及預後判斷指標.
목적 통과검측엄중폐좌상환자혈중풍·유륵포란덕인자(vWF),백개소8재수상후불동시점적함량,게시기동태변화규률급기림상개치.방법 장63례엄중폐좌상환자분성ARDS조화비ARDS조、생존조화사망조、ISS평분<20분화ISS평분≥20분조,병인입정상대조조,사용ELISA법분별검측상후24 h내、제3천、제5천、제7천시적혈장vWF화혈청IL-8수평,관찰기동태규률,병진행상관인소분석.결과 엄중폐좌상환자재각시점,혈장vWF화혈청IL-8균고우정상대조조.엄중폐좌상병발ARDS조혈장vWF함량각시점축점승고,ARDS조재제5천、제7천혈장vWF함량현저고우비ARDS조(P<0.05).혈청IL-8함량재제5천체도고봉후개시하강,량조지간재각시점차이구유통계학의의(P<0.05);사망조혈장vWF여혈청IL-8함량균현저고우생존조(P<0.05);ISS평분≥20분조혈장vWF화혈청IL-8수평균재제5천체도고봉후개시회락,ISS평분<20분조재제3천체도고봉후회락.혈장vWF함량여혈소판계수정정상관,여양합지수정부상관.혈청IL-8함량여백세포계수、ISS평분정정상관,여양합지수정부상관.결론 엄중폐좌상환자혈중vWF화IL-8함량정동태변화,반영료폐손상적정도,병가이작위엄중폐좌상후병발ARDS적예측급예후판단지표.
Objective To study the clinical changes of von Willebrand factor( vWF) and interleukin-8 (IL-8) in patients with severe pulmonary contusion. Methods Sixty-three patients with severe pulmonary contusion were divided into three different classifications for the sake of comparison in different respects, namely (1) severe pulmonary contusion with ARDS group and severe pulmonary contusion without ARDS group, (2) survival group and non-survival group, and (3) ISS score <20 group and ISS scored 20 group. In addition, the normal control group was set up. The levels of plasma vWF and serum IL-8 were respectively detected by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA) within 24 hours of injury and 1,3,5 and 7days after injury. The regularity of their changes was observed and the correlation factors were analyzed from the data. Results Compared with normal controls, the concentrations of plasma vWF and serum IL-8 were significantly increased in patients with severe pulmonary contusion in all intervals of detection. The concentrations of plasma vWF escalated gradually in severe pulmonary contusion with ARDS, and reached significantly higher levels in 5 days and 7 days after injury compared with those without ARDS group (P <0. 05). The increase in concentrations of serum IL-8 peaked in 5day after injury, and then declined. The levels of serum IL-8 were higher in patients with severe pulmonary contusion with ARDS group than those in this kind of patients without ARDS group. The levels of plasma vWF and serum IL-8 were higher in non - survival group than those in survival group (P < 0.05). The increase in levels of plasma vWF and serum IL-8 peaked and then declined in 5 days in ISS score 3:20 group, whereas it peaked and declined in 3 days after injury in ISS score < 20 group. The level of plasma vWF was positively correlated with platelets and negatively correlated with oxygenation index. The levels of serum IL-8 was positively correlated with white blood cell count and ISS score, and negatively correlated with oxygenation index. Conclusions The levels of plasma vWF and serum IL-8 were increased in patients with severe pulmonary contusion, reflecting the severity of pulmonary injury. The levels of plasma vWF and serum IL-8 were the sensitive markers for evaluating the severity of pulmonary injury and the prognosis of ARDS caused by severe pulmonary contusion.
