中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
9期
1-5
,共5页
盛鹰%谢晓洪%高波%王静恩%蔡金芳
盛鷹%謝曉洪%高波%王靜恩%蔡金芳
성응%사효홍%고파%왕정은%채금방
肺通气%呼吸窘迫综合征,成人%支气管肺泡灌洗
肺通氣%呼吸窘迫綜閤徵,成人%支氣管肺泡灌洗
폐통기%호흡군박종합정,성인%지기관폐포관세
Pulmonary ventilation%Respiratory distress syndrome,adult%Bronchoalveolar lavage
目的 观察肺保护通气策略(LPVS)对肺内外源性急性呼吸窘迫综合征(ARDS)患者支气管肺泡灌洗液(BALF)炎性介质的影响.方法 62例肺外源性ARDS(ARDSexp)患者按照随机数字表法分成ARDSexp观察组和ARDSexp对照组；60例肺内源性ARDS(ARDSp)患者按照随机数字表法分成ARDSp观察组和ARDSp对照组.ARDSexp观察组和ARDSp观察组患者采用LPVS[潮气量6～8 ml/kg,呼气末正压(PEEP)5～15 cm H2O(1 cm H2O =0.098 kPa)],ARDSexp对照组和ARDSp对照组患者则采用常规通气策略(潮气量10～ 12 ml/kg,PEEP 4～8 cm H2O)；所有患者均按ARDS常规治疗,机械通气模式及参数调整相同.采用酶联免疫吸附法测定第1、4、7天患者BALF肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8水平；检测第1～7天每天早晨8点患者氧合指数.结果 最终62例ARDSexp患者有4例以及60例ARDSp患者有6例因行机械通气后7d内死亡,被剔除本研究.ARDSexp观察组28例,ARDSexp对照组30例,ARDSp观察组28例,ARDSp 对照组26例.第1、2天,ARDSexp观察组和ARDSp观察组氧合指数与相应的ARDSexp对照组和ARDSp对照组比较差异均无统计学意义(P＞0.05),但第3～7天,ARDSexp观察组和ARDSp观察组氧合指数均高于相应的ARDSexp对照组和ARDSp对照组(P＜0.05)；而ARDSexp观察组与ARDSp观察组比较,除第1天差异无统计学意义(P＞0.05)外,ARDSexp观察组氧合指数均高于ARDSp观察组(P＜0.05).ARDSexp观察组和ARDSp观察组随着时间的推移,氧合指数均较前日有所改善(P＜0.05).ARDSexp观察组和ARDSp观察组BALF TNF-α、IL-6及IL-8水平在第4、7天均低于相应的ARDSexp对照组和ARDSp对照组,差异有统计学意义(P＜0.05).ARDSexp观察组和ARDSexp对照组BALF2 TNF-α、IL-6及IL-8水平均显著低于相应的ARDSp观察组和ARDSp对照组(P＜0.05).ARDSexp观察组和ARDSp观察组随着时间的推移,BALF TNF-α、IL-6及IL-8水平均呈下降趋势(P＜0.05).结论 和传统通气策略相比,LPVS的实施,可明显降低ARDS患者BALF炎性介质水平,提高ARDS患者的氧合指数,对于ARDSexp尤为明显.
目的 觀察肺保護通氣策略(LPVS)對肺內外源性急性呼吸窘迫綜閤徵(ARDS)患者支氣管肺泡灌洗液(BALF)炎性介質的影響.方法 62例肺外源性ARDS(ARDSexp)患者按照隨機數字錶法分成ARDSexp觀察組和ARDSexp對照組；60例肺內源性ARDS(ARDSp)患者按照隨機數字錶法分成ARDSp觀察組和ARDSp對照組.ARDSexp觀察組和ARDSp觀察組患者採用LPVS[潮氣量6～8 ml/kg,呼氣末正壓(PEEP)5～15 cm H2O(1 cm H2O =0.098 kPa)],ARDSexp對照組和ARDSp對照組患者則採用常規通氣策略(潮氣量10～ 12 ml/kg,PEEP 4～8 cm H2O)；所有患者均按ARDS常規治療,機械通氣模式及參數調整相同.採用酶聯免疫吸附法測定第1、4、7天患者BALF腫瘤壞死因子(TNF)-α、白細胞介素(IL)-6、IL-8水平；檢測第1～7天每天早晨8點患者氧閤指數.結果 最終62例ARDSexp患者有4例以及60例ARDSp患者有6例因行機械通氣後7d內死亡,被剔除本研究.ARDSexp觀察組28例,ARDSexp對照組30例,ARDSp觀察組28例,ARDSp 對照組26例.第1、2天,ARDSexp觀察組和ARDSp觀察組氧閤指數與相應的ARDSexp對照組和ARDSp對照組比較差異均無統計學意義(P＞0.05),但第3～7天,ARDSexp觀察組和ARDSp觀察組氧閤指數均高于相應的ARDSexp對照組和ARDSp對照組(P＜0.05)；而ARDSexp觀察組與ARDSp觀察組比較,除第1天差異無統計學意義(P＞0.05)外,ARDSexp觀察組氧閤指數均高于ARDSp觀察組(P＜0.05).ARDSexp觀察組和ARDSp觀察組隨著時間的推移,氧閤指數均較前日有所改善(P＜0.05).ARDSexp觀察組和ARDSp觀察組BALF TNF-α、IL-6及IL-8水平在第4、7天均低于相應的ARDSexp對照組和ARDSp對照組,差異有統計學意義(P＜0.05).ARDSexp觀察組和ARDSexp對照組BALF2 TNF-α、IL-6及IL-8水平均顯著低于相應的ARDSp觀察組和ARDSp對照組(P＜0.05).ARDSexp觀察組和ARDSp觀察組隨著時間的推移,BALF TNF-α、IL-6及IL-8水平均呈下降趨勢(P＜0.05).結論 和傳統通氣策略相比,LPVS的實施,可明顯降低ARDS患者BALF炎性介質水平,提高ARDS患者的氧閤指數,對于ARDSexp尤為明顯.
목적 관찰폐보호통기책략(LPVS)대폐내외원성급성호흡군박종합정(ARDS)환자지기관폐포관세액(BALF)염성개질적영향.방법 62례폐외원성ARDS(ARDSexp)환자안조수궤수자표법분성ARDSexp관찰조화ARDSexp대조조；60례폐내원성ARDS(ARDSp)환자안조수궤수자표법분성ARDSp관찰조화ARDSp대조조.ARDSexp관찰조화ARDSp관찰조환자채용LPVS[조기량6～8 ml/kg,호기말정압(PEEP)5～15 cm H2O(1 cm H2O =0.098 kPa)],ARDSexp대조조화ARDSp대조조환자칙채용상규통기책략(조기량10～ 12 ml/kg,PEEP 4～8 cm H2O)；소유환자균안ARDS상규치료,궤계통기모식급삼수조정상동.채용매련면역흡부법측정제1、4、7천환자BALF종류배사인자(TNF)-α、백세포개소(IL)-6、IL-8수평；검측제1～7천매천조신8점환자양합지수.결과 최종62례ARDSexp환자유4례이급60례ARDSp환자유6례인행궤계통기후7d내사망,피척제본연구.ARDSexp관찰조28례,ARDSexp대조조30례,ARDSp관찰조28례,ARDSp 대조조26례.제1、2천,ARDSexp관찰조화ARDSp관찰조양합지수여상응적ARDSexp대조조화ARDSp대조조비교차이균무통계학의의(P＞0.05),단제3～7천,ARDSexp관찰조화ARDSp관찰조양합지수균고우상응적ARDSexp대조조화ARDSp대조조(P＜0.05)；이ARDSexp관찰조여ARDSp관찰조비교,제제1천차이무통계학의의(P＞0.05)외,ARDSexp관찰조양합지수균고우ARDSp관찰조(P＜0.05).ARDSexp관찰조화ARDSp관찰조수착시간적추이,양합지수균교전일유소개선(P＜0.05).ARDSexp관찰조화ARDSp관찰조BALF TNF-α、IL-6급IL-8수평재제4、7천균저우상응적ARDSexp대조조화ARDSp대조조,차이유통계학의의(P＜0.05).ARDSexp관찰조화ARDSexp대조조BALF2 TNF-α、IL-6급IL-8수평균현저저우상응적ARDSp관찰조화ARDSp대조조(P＜0.05).ARDSexp관찰조화ARDSp관찰조수착시간적추이,BALF TNF-α、IL-6급IL-8수평균정하강추세(P＜0.05).결론 화전통통기책략상비,LPVS적실시,가명현강저ARDS환자BALF염성개질수평,제고ARDS환자적양합지수,대우ARDSexp우위명현.
Objective To observe the effects of lung protective ventilation strategy (LPVS) on inflammatory mediators in bronchial alveolar lavage fluid (BALF) in pulmonary and extrapulmonary acute respiratory distress syndrome(ARDS).Methods All of 62 extrapulmonary ARDS(ARDSexp) cases and 60 pulmonary ARDS (ARDSp) cases were divided into observation group and control group by table of random digit.ARDSexp and ARDSp observation group were received LPVS treatment [tidal volume 6-8 ml/kg,positive end expiratory pressure (PEEP) 5-15 cm H2O (1 cm H2O =0.098 kPa)],and ARDSexp and ARDSp control group were received the routine ventilation strategy (tidal volume 10-12 ml/kg,PEEP 4-8 cm H2O).All groups were treated with the same conventional therapy of ARDS,same model and parameter of mechanical ventilation.The level of tumor necrosis factor (TNF)-α,interleukin (IL)-6,IL-8 in BALF were tested by enzyme linked immunosorbent assay on the 1st,4th,7th day in each group.The oxygenation index was tested at 8 o'clock each morning.Results There were 4 ARDSexp cases and 6 ARDSp cases who were expelled,because of death within 7 days.ARDSexp observation group was in 28 cases,ARDSexp control group was in 30 cases,ARDSp observation group was in 28 cases,ARDSp control group was in 26 cases.The oxygenation index had no significant difference between ARDSexp and ARDSp observation group and corresponding ARDSexp and ARDSp control group on the 1st and 2nd day (P ＞ 0.05).But the oxygenation index in ARDSexp and ARDSp observation group were significantly higher than that in ARDSexp and ARDSp control group from 3rd to 7th day (P ＜ 0.05).The oxygenation index in ARDSexp observation group was significantly higher than that in ARDSp observation group except 1st day (P ＜0.05).The oxygenation index in ARDSexp and ARDSp observation group were significantly better with the time passing (P ＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were significantly lower than those in corresponding ARDSexp and ARDSp control group on the 4th and 7th day (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp observation group and ARDSexp control group were significantly lower than those in corresponding ARDSp observation group and ARDSp control group (P＜ 0.05).The BALF levels of TNF-α,IL-6 and IL-8 in ARDSexp and ARDSp observation group were decreased significantly with the time passing (P ＜0.05).Conclusion It is more reasonable to decrease the BALF levels of inflammatory mediators,increase oxygenation index for ARDS patients to with LPVS treatment,then for ARDSexp patients obviously.
