SP-D、KL-6评价呼吸机相关性肺损伤的初步研究  

A preliminary study on the evaluation of ventilator induced lung injury by the determination of serum markers of pulmonary surfactant-associated protein D(SP-D) and human Ⅱ pulmonary alveolus cell surface antigen(KL-6) concentration

作　　者：蒋光辉[1] 刘素芸 陶文强[1] 周雯[1] 万建国[1] 

机构地区：[1]南昌大学第三附属医院重症医学科,南昌330008

出　　处：《江西医药》2017年第12期1268-1270,1288,共4页Jiangxi Medical Journal

基　　金：江西省卫生厅科技计划;编号20150713

摘　　要：目的评价呼吸机相关性肺损伤的可行性。方法 25例急性呼吸窘迫综合征(ARDS)患者入选,所有患者采用肺保护通气策略,依据动脉血气分析、脉搏血氧饱和度(SpO_2)调整呼吸机参数,使动脉血PaO_2>60mm Hg,PaCO_2<50mm Hg。通气24h后以Pplat35cm H_2O为临界点分为高平台压组(Pplat>35cm H_2O),低平台压组(Pplat<35cm H2O),留取血标本。高平台压组采用个体化通气策略通气24h后留取血标本。记录发生气胸、纵膈气肿等严重呼吸机相关性肺损伤事件病例数并留取血标本。结果高平台压组SP-D(24.60±1.95)μg/ml、KL-6(8.39±0.67)μg/ml明显高于低平台压组SP-D(16.71±1.50)μg/ml、KL-6(3.48±0.99)μg/ml(P<0.05)。高平台压组采用个体化通气策略后SP-D(16.93±1.28)μg/ml、KL-6(3.54±0.69)μg/ml明显下降,P<0.05,高平台压组发生1例气胸且SP-D、(KL-6值明显升高。Pplat与血清中SP-D(r=0.881,P<0.05)、KL-6(r=0.840,P<0.05)之间呈正相关。结论血清标志物SP-D、KL-6可作为呼吸机相关性肺损伤指标,个体化通气策略可减轻呼吸机相关性肺损伤。Objective The feasibility evaluation of ventilator-induced lung injury by the determination of serum markers of pulmonary surfactant-associated protein D(SP-D) and human Ⅱpulmonary alveolus cell surface antigen(KL-6) concentration.Methods Twenty-five ARDS patients were enrolled;all patients were treated with lung protetive ventilation strategy. The adjustment of mechanical ventilation parameters based on the analysis of arterial blood gas,pulse oxygen saturation(SpO_2). The arterial blood PaO_2>60 mm Hg,PaCO_2<50 mm Hg. These patients were divided into two groups after based on 35 cm H_2O of plateau pressure for critical points:more than 35 cm H_2O,low platform pressure group less than 35 cm H_2O. and In the high platform pressure group,blood samples were collected The occurrence of pneumothorax,mediastinal emphysema and other serious cases of ventilator-associated lung injury events were recorded and the blood samples were obtained. Results SP-D(24.60±1.95)μg/ml,KL-6(8.39±0.67)μg/ml was significantly higher than that of low pressure group(16.71±1.50)μg/ml,KL-6(3.48±0.99)μg/ml P<0.05,after 24 hours in the high platform pressure group SP-D(16.93±1.28)μg/ml,KL-6(3.54±0.69)μg/ml decreased significantly,P<0.05. Pneumothorax was occurred in high pressure platform group,SP-D and KL-6 were increased significantly. Pplat was positively correlated with concentrations of SP-D and KL-6(r =0.881,r =0.840,respectively). Conclusion The serum markers of SP-D and KL-6 would serve as biochemical index for ventilator-associated lung injury. Individual ventilation would reduce the occurrence rate of ventilator-associated lung injury.

关 键 词：呼吸机相关性肺损伤 肺保护通气策略 人Ⅱ型肺泡表面抗原 个体化通气 

分 类 号：R563.8[医药卫生—呼吸系统]