血清TLR-4在复苏后肺损伤中的表达与机械通气影响  

Expression of serum TLR-4 in lung injury after resuscitation and the effect of mechanical ventilation

作　　者：毛洪涛[1] 黄亮[1] 曹春水[1] 熊华威[1] 刘勇[1] MAO Hongtao;HUANG Liang;CAO Chunshui;XIONG Huawei;LIU Yong(the Department of Emergency Medicine,First Affiliated Hospital of Nanchang University,Nanchang Jiangxi 330006,China.)

机构地区：[1]南昌大学第一附属医院急诊科,南昌330006

出　　处：《江西医药》2018年第1期4-7,共4页Jiangxi Medical Journal

基　　金：江西省教育厅科技项目;编号GJJ13137

摘　　要：目的观察不同潮气量及呼气末正压(PEEP)机械通气对复苏后综合征患者氧合指数(OI)、肺损伤评分(LIS)、血清TLR-4(TLR-4)表达的影响,探讨心肺复苏后肺损伤机制及机械通气方式。方法选择我院2013年1月-2016年1月收治的心搏骤停后复苏后综合征患者24例,采用数字表法随机分为A1、A2、A3、B1、B2、B3组,每组4例。A1组采用低潮气量(6ml/kg)+低PEEP[3cm H_2O(1cm H_2O=0.098k Pa)]。A2组采用低潮气量(6ml/kg)+中等PEEP(6cm H_2O)。A3组采用低潮气量(6ml/kg)+高PEEP(12cm H_2O)。B1组采用常规潮气量(10ml/kg)+低PEEP(3cm H_2O)。B2组采用常规潮气量(10ml/kg)+中等PEEP(6cm H_2O)。B3组中采用常规潮气量(10ml/kg)+高PEEP(12cm H_2O)。经心肺复苏自主循环恢复后开始计时,观察并记录各组患者1h、6h、12h、24h时氧合指数、血首页下6h、12h相比,OI降低(P<0.05);组间各时间点比较,A2组24h与其他各组同时间点相比,OI升高(P<0.05)。⑵各组24h LIS分值为0.5-2.5分,平均(1.5±1.0)分,与其他各组相比,A2组LIS低于其他各组(P<0.05)。⑶各组血清TLR-4水平随着时间延长均升高,组内比较,各组12h、24h较1h时间点TLR-4水平升高(P<0.05);与其他各组同时间点相比,A2组12h、24h时TLR-4水平低于其他各组(P<0.05)。结论心肺复苏后血清TLR-4表达升高并呈现肺损伤表现,低潮气量(6ml/Kg)+中等PEEP(6cm H_2O)可能是心肺复苏后24h内较为合理的机械通气方式。Objective To observe the effects of different tidal volume and positive end-expiration pressure(PEEP)mechanical ventilation on the expression of oxygenation index(OI),lung injury score(LIS)and serum TLR-4(TLR-4)in patients with post-resuscitation syndrome,Mechanism of post-resuscitation lung injury and mechanical ventilation.Methods Twenty-four patients with post-resuscitation syndrome were enrolled in this study.The patients were randomly divided into A1,A2,A3,B1,B2 and B3 groups,Each group of 4 cases.A1 group was treated with low tidal volume(6ml/kg)+low PEEP[3cmH2O(1cmH2O=0.098kPa)].A2 group was treated with low tidal volume(6ml/kg)+medium PEEP(6cmH2O).The low tidal volume(6ml/kg)+high PEEP(12cmH2O)was used in A3 group.B1 group used conventional tidal volume(10ml/kg)+low PEEP(3cmH2O).Group B2 was treated with conventional tidal volume(10ml/kg)+medium PEEP(6cmH2O).Routine tidal volume(10ml/kg)+high PEEP(12cmH2O)was used in group B3.The oxygenation index,serum Toll-like receptor protein-4 level and 24h lung injury score were observed and recorded at 1h,6h,12h and 24h after cardiopulmonary resuscitation.Results⑴Group at each time point comparison,the OI decreased(P<0.05)compared with the control group at 24 hour and 1 hour,6 hour and 12 hour,respectively;Compared with other groups at the same time point,OI increased(P<0.05).⑵At 24 hour LIS score of each group was 0.5-2.5,average(1.5±1.0)points,compared with other groups,LIS was lower in group A2 than in other groups(P<0.05).⑶The level of serum TLR-4 in each group increased with the prolongation of time,and the level of TLR-4 increased at 12 hour and 24 hour after 1 hour(P<0.05);Compared with other groups at the same time point,TLR-4 level was lower in A2 group than in other groups at 12 hour and 24 hour(P<0.05).Conclusion After cardiopulmonary resuscitation serum TLR-4 expression increased and showed lung injury performance,Low tidal volume(6ml/Kg)+medium PEEP(6cmH2O)may be more reasonable after 24 hour months of cardiopulmonary resuscitation of mechanical

关 键 词：复苏后综合征 机械通气 潮气量 呼吸末正压 LIS TLR-4 

分 类 号：R614[医药卫生—麻醉学]