对机械通气患者呼出气冷凝液中过氧化氢的研究  

Determination of the hydrogen peroxide level in exhaled breath condensate of patients under mechanical ventilation

作　　者：杨国辉[1] 王广发[1] 

机构地区：[1]北京大学第一医院呼吸科,100034

出　　处：《中国危重病急救医学》2008年第6期324-326,共3页Chinese Critical Care Medicine

基　　金：国家自然科学基金资助项目（30340030）

摘　　要：目的探讨呼吸重症加强治疗病房（RICU）机械通气患者呼出气冷凝液（EBC）中过氧化氢（H2O2）浓度与呼吸道炎症反应及预后的关系。方法采用自行设计的EBC收集器，对36例机械通气患者在通气1、3、5和7d收集呼气端的EBC，应用化学荧光法测定EBC中H2O2浓度，并进行统计学分析。结果存活组机械通气3、5和7d EBC中H2O2浓度较1d明显降低，差异有统计学意义[（0．105±0．032）μmol／L、（0．072±0．034）μmol／L、（0．047±0．029）μmol／L比（0．192±0．135）μmol／L，P均〈0．05]；且7d时EBC中H2O2较3d明显降低（P〈0．05），虽较5d时有所降低，但差异无统计学意义（P〉0．05）。死亡组机械通气7d EBC中H2O2浓度较1、3和5d明显升高，差异有统计学意义[（0．234±0．152）μmol／L比（0．055±0．029）μmol／L、（0．088±0．040）μmol／L、（0．150±0．134）μmol／L，P均〈0．05]；5d时EBC中H2O2较1d明显升高（P〈0．05），虽较3d时有所降低，但差异无统计学意义（P〉0．05）。与存活组比较，死亡组机械通气1d EBC中H2O2浓度明显降低（P〈0．05）；3d也有所降低，但差异无统计学意义（P〉0．05）；5d和7d时明显增高，差异有统计学意义（P均〈0．05）。存活组和死亡组机械通气患者EBC中H2O2浓度与APACHEⅡ、Ⅲ评分均无相关性（P均〉0．05）。结论EBC中H2O2水平的高低与病情严重程度有关，故可作为机械通气患者气道炎症反应的重要监测指标，并可作为评估机械通气患者治疗和预后的重要监测指标。Objective To determine hydrogen peroxide （H2O2） content in condensate of exhaled breath （EBC） in order to explore its relation with intensify of inflammation of the respiratory tract and prognosis of the patients under mechanical ventilation in respiratory intensive care unit （RICU）. Methods Thirty-six patients undergoing mechanical ventilation were studied. EBC was collected on the 1, 3,5,7 days after mechanical ventilation. H2O2 in EBC was measured fluorimetrically. Results A significantly lowered H2O2 level in the survivors was observed on day 3 [（0.105±0.032） μmol/L], day 5[（0.072 ± 0. 034）μmol/L] and day 7 [（0. 047±0. 029）μmol/L] compared with day 1 [（0. 192±0. 135） μmol/L] after mechanical ventilation （all P〈0.05）. A significantly lowered H2O2 level was observed on day 7 compared with day 3 （P〈0.05） after mechanical ventilation. There was no difference in the H2O2 level on day 7 compared with day 5 （P〉0.05）. A significant lower H2O2 level was observed in non-survivors on day 1 [（0. 055 ± 0. 029）μmol/L], and day 3 [（0. 088±0. 040）μmol/L] and day 5 [（0. 150±0. 134）μmol/L] compared with day 7 [（0. 234±0. 152）μmol/L] after mechanical ventilation （all P〈0.05）. A significantly lower H2O2 level was observed on day 1 compared with day 5 （P〈0.05） after mechanical ventilation. There was no difference in the H2O2 level on day 1 compared with day 3 （P〉0.05）. A significantly lower H2O2 level in non-survivor compared with survivors on day 1 after mechanical ventilation （P〈0.05）; There was no difference in the H2O2 level between non-survivors and survivors on day 3 after mechanical ventilation （P〉0.05）. A significantly higher H2O2 level in non-survivors compared with that of survivors on day 5 and day 7 after mechanical ventilation （P〈0.05, respectively）. The levels of H2O2 in EBC in survivors and non-survivors undergoing mechanical ventilation showed no correlation with acute physiology and chronic health eva

关 键 词：机械通气 呼出气冷凝液 过氧化氢 

分 类 号：R459.7[医药卫生—急诊医学]