亚低温治疗急性呼吸窘迫综合征患者对炎性反应影响及肺保护作用的研究  

The effect of mild hypothermia on inflammation status and lung function protection in patients with acute respiratory distress syndrome

作　　者：黄昭[1] 王思荣[1] 陈裕胜[1] 刘继云[1] 

机构地区：[1]广州市第一人民医院危重症监护中心,510180

出　　处：《中国医师进修杂志》2010年第19期21-24,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 探讨亚低温治疗对急性呼吸窘迫综合征（ARDS）患者血清炎性介质水平、肺功能保护及临床预后的影响.方法 本研究为对照性研究,选取56例1997-2007年住院的ARDS患者按入院时查分组表进行随机分组.其中29例接受常规治疗加亚低温治疗（治疗组）,27例仅接受常规治疗（对照组）.所有患者均于治疗前及治疗后3、7 d时抽血检测血浆肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及C反应蛋白（CRP）水平,同时记录患者氧合指数、SOFA评分及肺损伤性评分,比较28 d内两组患者生存率等临床指标,并详细记录各种不良反应.结果 治疗组TNF-α、IL-6及CRP水平均显著低于对照组,同时氧合指数、SOFA评分及肺损伤性评分亦较对照组明显改善（P〈0.05）;且28 d内治疗组生存率高于对照组[65.5%（19/29）比51.9%（14/27）],而机械通气时间[（11.9±3.6）d比（17.0±5.1）d]、ICU住院时问[（14.1±4.2）d比（21.5±7.7）d]明显缩短（P〈0.05）.结论 亚低温治疗能显著缓解ARDS患者机体炎性反应,有效改善肺部氧合及短期预后.Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome （ARDS）.Methods All of 56 patients with ARDS were randomly divided into two groups： trial group （29 patients,treatment with mild hypothermia） and control group （27 patients, treatment with common practice）. The following parameters including tumor necrosis factor （TNF）-α,interleukin （IL）-6 and C reactive protein （CRP）, oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group （P〈0.05 ）. The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%（19/29） vs 51.9%（14/27）]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [（11.9±3.6）d vs （17.0±5.1）d,（14.1±4.2）d vs （21.5±7.7）d]（P〈0.05）. Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.

关 键 词：呼吸窘迫综合征 成人 低温 细胞因子类 

分 类 号：R563.8[医药卫生—呼吸系统]