中国基层医药
中國基層醫藥
중국기층의약
CHINESE JOURNAL OF PRIMARY MEDICINE AND PHARMACY
2014年
19期
2881-2883,2884
,共4页
杨春燕%张汝敏%张芸%王世富
楊春燕%張汝敏%張蕓%王世富
양춘연%장여민%장예%왕세부
血管外肺水%肿瘤坏死因子-α%E-选择素%血管抑制素类%呼吸窘迫综合征,成人
血管外肺水%腫瘤壞死因子-α%E-選擇素%血管抑製素類%呼吸窘迫綜閤徵,成人
혈관외폐수%종류배사인자-α%E-선택소%혈관억제소류%호흡군박종합정,성인
Extravascular lung water%Tumor necrosis factor alpha%E-selectin%Angiostatins%Respiratory dis-tress syndrome,adult
目的：分析血管外肺水（ EVLW）、肿瘤坏死因子-α（ TNF-α）、E-选择素、血管抑制因子-2与急性呼吸窘迫综合征（ ARDS）的相关性，探讨EVLW、TNF-α、E-选择素、血管抑制因子-2在ARDS病情严重程度及预后判断中的参考价值。方法选择36例ARDS患者进行PiCCO监测，根据PiCCO监测指标血管外肺水指数（ EVLWI）的高低分为两组，EVLWI≥14 mL/kg组和EVLWI＜14 mL/kg组，监测记录患者EVLWI、PVPI、CI、ITBVI等血流动力学指标，观察患者血气分析结果，记录氧合指数、计算APACHEⅡ评分，应用ELISA方法检测两组患者血清TNF-α、E-选择素、血管抑制因子-2水平。结果 EVLWI≥14 mL/kg组患者APACHEⅡ评分为（23．93±4．44）分、28 d病死率为61．1％、ICU住院时间为（19．05±4．0） d，均较 EVLWI ＜14 mL/kg组[APACHEⅡ评分为（18．58±3．66）分、28 d病死率为27．8％、ICU住院时间为（14．35±3．39）d]高（t＝3．941，χ2＝4．050，t＝3．797，均P＜0．01）；同时血清TNF-α为（85．28±18．25）μg/L、E-选择素为（74．07±14．57）μg/L，也较EVLWI＜14 mL/kg组[TNF-α为（63．27±20．28）μg/L、E-选择素为（40．99±16．35）μg/L]高（t＝3．422、5．847，均P＜0．01）；EVLWI≥14 mL/kg组氧合指数为（122．86±25．45），较EVLWI＜14 mL/kg组的（156．77±37．58）低（t＝-3．170，P＜0．01）。两组中28 d内仍存活的20例患者（存活组），在入组后经72 h积极治疗后EVLWI明显下降（Z＝-0．392，P＜0．01），氧合指数较前升高（Z＝-3．845，P＜0．01），且TNF-α、E-选择素水平均较前下降（t＝7．194、4．025，均P＜0．01）；而死亡组16例患者经72 h积极治疗后EVLWI、TNF-α、E-选择素水平较前无下降，氧合指数较前无改善，差异无统计学意义（均P＞0．05）。 EVLWI 与PVPI、EVLWI 与TNF-α、EVLWI与E-选择素均呈显著正相关（r＝0．605、0．649、0．549，均P＜0．01），EVLWI与氧合指数有明显负相关（r＝-0．715，P＜0．01）。两组患者血管抑制因子-2水平差异无统计学意义（P＞0．05）。结论 ARDS患者EVLWI与TNF-α、E-选择素均具有相关性， EVLWI、TNF-α、E-选择素水平越高，患者28 d病死率越高、ICU住院时间越长。 EVLWI、TNF-α、E-选择素可以对ARDS病情严重程度及预后判断提供参考价值。血管抑制因子-2与EVLWI水平无相关性。
目的：分析血管外肺水（ EVLW）、腫瘤壞死因子-α（ TNF-α）、E-選擇素、血管抑製因子-2與急性呼吸窘迫綜閤徵（ ARDS）的相關性，探討EVLW、TNF-α、E-選擇素、血管抑製因子-2在ARDS病情嚴重程度及預後判斷中的參攷價值。方法選擇36例ARDS患者進行PiCCO鑑測，根據PiCCO鑑測指標血管外肺水指數（ EVLWI）的高低分為兩組，EVLWI≥14 mL/kg組和EVLWI＜14 mL/kg組，鑑測記錄患者EVLWI、PVPI、CI、ITBVI等血流動力學指標，觀察患者血氣分析結果，記錄氧閤指數、計算APACHEⅡ評分，應用ELISA方法檢測兩組患者血清TNF-α、E-選擇素、血管抑製因子-2水平。結果 EVLWI≥14 mL/kg組患者APACHEⅡ評分為（23．93±4．44）分、28 d病死率為61．1％、ICU住院時間為（19．05±4．0） d，均較 EVLWI ＜14 mL/kg組[APACHEⅡ評分為（18．58±3．66）分、28 d病死率為27．8％、ICU住院時間為（14．35±3．39）d]高（t＝3．941，χ2＝4．050，t＝3．797，均P＜0．01）；同時血清TNF-α為（85．28±18．25）μg/L、E-選擇素為（74．07±14．57）μg/L，也較EVLWI＜14 mL/kg組[TNF-α為（63．27±20．28）μg/L、E-選擇素為（40．99±16．35）μg/L]高（t＝3．422、5．847，均P＜0．01）；EVLWI≥14 mL/kg組氧閤指數為（122．86±25．45），較EVLWI＜14 mL/kg組的（156．77±37．58）低（t＝-3．170，P＜0．01）。兩組中28 d內仍存活的20例患者（存活組），在入組後經72 h積極治療後EVLWI明顯下降（Z＝-0．392，P＜0．01），氧閤指數較前升高（Z＝-3．845，P＜0．01），且TNF-α、E-選擇素水平均較前下降（t＝7．194、4．025，均P＜0．01）；而死亡組16例患者經72 h積極治療後EVLWI、TNF-α、E-選擇素水平較前無下降，氧閤指數較前無改善，差異無統計學意義（均P＞0．05）。 EVLWI 與PVPI、EVLWI 與TNF-α、EVLWI與E-選擇素均呈顯著正相關（r＝0．605、0．649、0．549，均P＜0．01），EVLWI與氧閤指數有明顯負相關（r＝-0．715，P＜0．01）。兩組患者血管抑製因子-2水平差異無統計學意義（P＞0．05）。結論 ARDS患者EVLWI與TNF-α、E-選擇素均具有相關性， EVLWI、TNF-α、E-選擇素水平越高，患者28 d病死率越高、ICU住院時間越長。 EVLWI、TNF-α、E-選擇素可以對ARDS病情嚴重程度及預後判斷提供參攷價值。血管抑製因子-2與EVLWI水平無相關性。
목적：분석혈관외폐수（ EVLW）、종류배사인자-α（ TNF-α）、E-선택소、혈관억제인자-2여급성호흡군박종합정（ ARDS）적상관성，탐토EVLW、TNF-α、E-선택소、혈관억제인자-2재ARDS병정엄중정도급예후판단중적삼고개치。방법선택36례ARDS환자진행PiCCO감측，근거PiCCO감측지표혈관외폐수지수（ EVLWI）적고저분위량조，EVLWI≥14 mL/kg조화EVLWI＜14 mL/kg조，감측기록환자EVLWI、PVPI、CI、ITBVI등혈류동역학지표，관찰환자혈기분석결과，기록양합지수、계산APACHEⅡ평분，응용ELISA방법검측량조환자혈청TNF-α、E-선택소、혈관억제인자-2수평。결과 EVLWI≥14 mL/kg조환자APACHEⅡ평분위（23．93±4．44）분、28 d병사솔위61．1％、ICU주원시간위（19．05±4．0） d，균교 EVLWI ＜14 mL/kg조[APACHEⅡ평분위（18．58±3．66）분、28 d병사솔위27．8％、ICU주원시간위（14．35±3．39）d]고（t＝3．941，χ2＝4．050，t＝3．797，균P＜0．01）；동시혈청TNF-α위（85．28±18．25）μg/L、E-선택소위（74．07±14．57）μg/L，야교EVLWI＜14 mL/kg조[TNF-α위（63．27±20．28）μg/L、E-선택소위（40．99±16．35）μg/L]고（t＝3．422、5．847，균P＜0．01）；EVLWI≥14 mL/kg조양합지수위（122．86±25．45），교EVLWI＜14 mL/kg조적（156．77±37．58）저（t＝-3．170，P＜0．01）。량조중28 d내잉존활적20례환자（존활조），재입조후경72 h적겁치료후EVLWI명현하강（Z＝-0．392，P＜0．01），양합지수교전승고（Z＝-3．845，P＜0．01），차TNF-α、E-선택소수평균교전하강（t＝7．194、4．025，균P＜0．01）；이사망조16례환자경72 h적겁치료후EVLWI、TNF-α、E-선택소수평교전무하강，양합지수교전무개선，차이무통계학의의（균P＞0．05）。 EVLWI 여PVPI、EVLWI 여TNF-α、EVLWI여E-선택소균정현저정상관（r＝0．605、0．649、0．549，균P＜0．01），EVLWI여양합지수유명현부상관（r＝-0．715，P＜0．01）。량조환자혈관억제인자-2수평차이무통계학의의（P＞0．05）。결론 ARDS환자EVLWI여TNF-α、E-선택소균구유상관성， EVLWI、TNF-α、E-선택소수평월고，환자28 d병사솔월고、ICU주원시간월장。 EVLWI、TNF-α、E-선택소가이대ARDS병정엄중정도급예후판단제공삼고개치。혈관억제인자-2여EVLWI수평무상관성。
Objective To analyze the correlations between acute respiratory distress syndrome ( ARDS) and extravascular lung water(EVLW),tumor necrosis factor alpha (TNF-α),E-selectin,vasostatin-2.To discuss the value of EVLW, TNF-α, E-selectin and vasostatin-2 in evaluating the severity of ARDS and prognosis of this disease . Methods There are thirty-six patients with ARDS were selected .According to the level of EVLWI shown by pulse indicator continuous cardiac output ( PiCCO) monitor,they were divided into the two groups:EVLWI≥14mL/kg group (n=18) and EVLWI<14mL/kg group(n=18).To monitor and record the levels of EVLWI ,PVPI,CI,ITBV,record oxygenation index ,calculate APACHEII score .The levels of TNF-α,E-selectin and vasostatin-2 in serum were meas-ured by ELISA.Results In EVLWI≥14mL/kg group,the APACHEⅡscore was (23.93 ±4.44),28-day mortality was 61.1%,the stay time in ICU was (19.05 ±4.0) d,which were higher than those in EVLWI <14mL/kg group [APACHEII score (18.58 ±3.66),28-day mortality(27.8%),the stay time in ICU(14.35 ±3.39) d](t=3.941,χ2 =4.050,t=3.797,all P<0.01).And the levels of TNF-α[(85.28 ±18.25)μg/L]and E-selectin[(74.07 ± 14.57)μg/L]in serum were higher than in EVLWI <14mL/kg group[TNF-α(63.27 ±20.28)μg/L,E-selectin (40.99 ±16.35)μg/L](t=3.422,5.847,all P<0.01).The oxygenation index of EVLWI≥14mL/kg group was (122.86 ±25.45),which was lower than that in EVLWI <14mL/kg group[(156.77 ±37.58)](t=-3.170,P<0.01).In the two groups of patients still alive within 28 days,after active treatment for 72 hours,the level of EVLWI was significantly lower than before in these 20 patients(Z=-0.392,P<0.01),oxygenation index was significantly higher than before(Z=-3.845,P<0.01),and the levels of TNF-αand E-selectin were significantly lower than before(t=7.194,4.025,all P<0.01).But 16 patients in the death group,after active treatment for 72 hours,the levels of EVLWI ,TNF-α,E-selectin and oxygenation index had no significant change ,there was no statistically signifi-cant difference(P>0.05).EVLWI had positive correlation with PVPI,TNF-αand E-selectin (r=0.605,0.649, 0.549,all P<0.01),and EVLWI had a negative correlation with oxygenation index (r=-0.715,P<0.01).Results showed no difference in vasostatin-2 between the two groups(P>0.05).Conclusion There were significant correla-tions between EVLWI and TNF-α,E-selectin in patients with ARDS.The levels of EVLWI,TNF-α,E-selectin were higher,and the mortality rate was higher,the the stay time in ICU was longer.The levels of EVLWI,TNF-αand E-selectin can provide a good reference value to the judgement of the severity of disease and prognosis in patients with ARDS.The level of vasostatin-2 had no correlation with EVLWI .
