外源性白蛋白输注对早期急性呼吸窘迫综合征肺毛细血管蛋白渗漏的影响  

The effect of exogenous albumin infusion on pulmonary capillary protein leakage in patients with acute respiratory distress syndrome at early stage

作　　者：宋晓聪[1] 胡丹[2] 郇姗姗[2] 曲彦[2] 关纯[2] 丁晓静[2] 南桂英[1] 

机构地区：[1]沧州医学高等专科学校,河北沧州066001 [2]青岛市市立医院,山东青岛266011

出　　处：《中国中西医结合急救杂志》2012年第2期68-70,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：基金项目：山东省青岛市科技支撑计划项目（09-1-1-4-nsh）

摘　　要：目的初步探讨急性期急性呼吸窘迫综合征（ARDS）患者补充外源性白蛋白对血清白蛋白（Alb）水平的影响，及血清Alb水平与肺毛细血管蛋白渗漏严重程度的相关性。方法将60例急性期ARDS患者按入院先后顺序随机分为两组，每组30例。治疗组患者于确诊后1d给予人血白蛋白20g，d静脉输注，连续3d，其他治疗方案与对照组相同。采用酶联免疫吸附法（ELISA）检测患者治疗前后血清Alb和C-反应蛋白（CRP）水平；并于ARDS诊断第3日进行支气管肺泡灌洗，采用ELISA法检测支气管肺泡灌洗液（BALF）中Alb水平。比较两组患者治疗前后血清Alb及CRP水平，分析毛细血管蛋白渗漏程度与血清Alb水平的相关性。结果与对照组比较，治疗组患者治疗后血清Alb水平（g／L）明显升高（30．86±3．05比28．01±2．19），CRP水平（mg／L）明显降低（65．98±31．80比86．00±25．41），差异均有统计学意义（均P〈0．05）。治疗组患者BALF中Alb水平（g／L）明显低于对照组（1．504±0．495比1．790±0．389，P〈O．05）。血清Alb水平与BALF中Alb水平呈显著负相关（r=-0．701，P〈O．05）。结论早期给予ARDS患者外源性白蛋白输注，可以有效维持患者血清Alb水平，遏制蛋白从肺毛细血管漏出。Objective To approach the effect of exogenous albumin infusion on the level of serum albumin （Alb） and to investigate the relevance between serum Alb level and the severity of pulmonary capillary protein leakage in patients with acute respiratory distress syndrome （ARDS） at acute stage. Methods Sixty cases of acute stage ARDS patients were randomly divided into treatment group and control group （30 cases in each group）. On the first day after ARDS diagnosis, both groups received conventional treatment, additionally the treatment group was given intravenous infusion of 20 g/d human albumin for 3 days. The serum Alb and C-reactive protein （CRP） levels were tested before and after treatment by enzyme-linked immunosorbent assay （ELISA）. On the third day after ARDS diagnosis, the bronchoalveolar lavage fluid （BALF） sample was obtained ; the level of Alb in BALF was tested by ELISA. The levels of serum Alb and CRP before and after the treatment in the two groups were compared, and the relevance between the severity of pulmonary capillary protein leakage and serum Alb level was analyzed. Results Compared to the control group, after treatment the serum Alb level （g/L）was significantly increased （30.86±3.05 vs. 28.01±2.19）, while CRP level （mg/L） was obviously decreased （ 65.98 ± 31.80 vs. 86.00-4- 25.41 ） in treatment group, the differences being statistically significant （both P〈0.05）. The Alb level （g/L） of BALF in treatment group was significantly lower than that in control group （1.504±0.495 vs. 1.790±0.389,P〈0.05）. The serum Alb level was negatively correlated with that in BALF （r=-0.701, P〈0.05）. Conclusion Infusion of exogenous albumin in the early stage of ARDS patients can effectively maintain the serum Alb level and inhibit protein leakage from pulmonary capillaries.

关 键 词：急性呼吸窘迫综合征 人血白蛋白 肺毛细血管蛋白渗漏 支气管肺泡灌洗液 

分 类 号：R256.1[医药卫生—中医内科学] R563.8[医药卫生—中医学]