机械通气不同时段内气道黏膜损伤的临床观察  

A clinical observation of airway mucosal injury as a result of mechanical ventilation for different duration

作　　者：王雪[1] 胡洋[1] 刘洋[1] 李刚[1] 金英[1] 朱安峰[2] 

机构地区：[1]长春市中心医院ICU,吉林130051 [2]长春市中心医院 病理科,吉林130051

出　　处：《中国危重病急救医学》2009年第10期587-589,共3页Chinese Critical Care Medicine

基　　金：基金项目：吉林省长春市科技计划项目（06GG40）

摘　　要：目的观察机械通气不同时段内患者气道黏膜细胞损伤的情况。方法选择因脑血管疾病行有创机械通气的144例患者，于机械通气后不同时段取下呼吸道分泌物，显微镜下检查脱落细胞形态学改变。观察机械通气〈8h（28例）、8～24h（46例）、24h～3d（22例）、3～7d（20例）、7～28d（14例）、≥28d（14例）6个不同时段内气道黏膜细胞损伤情况。结果随机械通气时间延长，气管、支气管黏膜细胞损伤程度逐渐加重，〈8h组气道黏膜细胞结构大致正常，8～24h组、24h～3d组多呈轻度损伤，3～7d组多呈中度甚至重度损伤，7～28d组与≥28d组气管、支气管黏膜细胞损伤程度均为重度，除7～28d组与≥28d组间比较无差异外，其余时间点比较差异均有统计学意义（P均〈O．05）。机械通气时间与气道黏膜损伤程度相关系数为0．781，P〈O．05，两者间存在线性相关关系。结论机械通气时间与气道黏膜损伤程度有线性相关关系；随着通气时间延长，损伤加重，8h后可出现显著损伤，但超过7d后损伤程度无差异。Objective To observe the pathological changes in exfoliated cells from lower respiratory tract mueosa in patients undergoing mechanical ventilation for various duration. Methods The secretion of lower respiratory traet was eollected in 144 patients of cerebral vascular diseases undergoing invasive mechanical ventilation, and exfoliated cells were examined under microscope at different time points. According to specimen collection time they were divided into five groups： less than 8 hours （28 cases）, 8 - 24 hours （46 eases）, 24 hours - 3 days （22 cases）, 3 - 7 days （20 cases）, 7 28 days （14 eases）, and over 28 days （14 cases）. Then the injury to airway mucosa at different time of mechanical ventilation was determined. Results The mueosal injury of trachea and bronchia was worsened gradually with the prolongation of mechanical ventilation. Airway mueosa structure of less than 8-hour of mechanical ventilation was generally normal, while most cells after 8 - 24 hours and 24 hours - 3 days of ventilation showed mild injury, and most cells from tracheal and bronchial mucosa showed severe injury after 3 - 7 days, 7 - 28 days and over 28 days of ventilation. Except the difference was not statistically significant between 7 - 28 days and over 28 days group （P〉0. 05）, the differenees between remaining groups were statistically significant （all P〈0.05）. The correlated coeffieient between the duration of mechanical ventilation and airway mucosal injury was 0. 781 （P〈0.05）, and the difference was statistically significant. Conclusion There are linear correlation between length of mechanical ventilation and the airway mueosal cell injury; injuries emerges when the mechanical ventilation time exceeds 8 hours with the prolongation mechanical ventilation time, there is severe damage of airway mucosa when mechanical ventilation lasted more than 7 days, but there is no difference in extent of injury after 7 days.

关 键 词：机械通气 气管 支气管 黏膜细胞 

分 类 号：R686[医药卫生—骨科学]