肺保护通气策略对肺内外源性急性呼吸窘迫综合征患者支气管肺泡灌洗液炎性介质的影响  

Effects of lung protective ventilation strategy on inflammatory mediators in bronchial alveolar lavage fluid in pulmonary and extrapulmonary acute respiratory distress syndrome

作　　者：盛鹰[1] 谢晓洪[1] 高波[1] 王静恩[1] 蔡金芳[1] 

机构地区：[1]复旦大学附属浦东医院重症医学科,上海201399

出　　处：《中国医师进修杂志》2013年第9期1-5,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：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6～8ml／kg，呼气末正压（PEEP）5～15cmH20（1cmH20=0．098kPa）]，ARDSexp对照组和ARDSp对照组患者则采用常规通气策略（潮气量10～12ml／kg，PEEP4～8cinH20）；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〈O．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BALFTNF-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BALFTNF-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（尸〈0．05）。ARDSexp观察组和ARDSp观察组随着时间的推�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） eases 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 H=O （1 cm H20 = 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 H20）. 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 lst,gth,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 observati

关 键 词：肺通气 呼吸窘迫综合征 成人 支气管肺泡灌洗 

分 类 号：R563.8[医药卫生—呼吸系统]