严重脓毒症患者氧供氧耗失衡与促炎抗炎失衡相关关系分析  

The correlation analysis between imbalance of oxygen supply and demand with imbalance of inflammation and antiinflammation for severe sepsis patients

作　　者：苏明华[1] 章晓红[1] SU Minghua;ZHANG Xiaohong(Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院,四川省人民医院,成都610072

出　　处：《实用医学杂志》2018年第14期2366-2368,2373,共4页The Journal of Practical Medicine

基　　金：四川省卫生厅科研课题项目(编号:090489)

摘　　要：目的动态监测严重脓毒症患者氧供氧耗指标肺泡-动脉氧分压差(P[A-a]O2)、血乳酸(LAC)、碱剩余(BE)与促炎、抗炎因子肿瘤坏死因子α(TNF-α)、白介素10(IL-10)变化相关关系及其临床价值。方法 2014年1月至2016年1月我院EICU收治的50例严重脓毒症患者,按预后分为存活组与死亡组,动态监测入院第1、3、5、7天P[A-a]O2、LAC、BE、TNF-α、IL-10。结果存活组P[A-a]O2初期升高不明显,第3天达峰值水平,之后第5、7天持续下降;死亡组P[A-a]O2初期即升高,并持续升高趋势。存活组LAC、BE均第1天最高,之后迅速下降至正常范围;死亡组LAC持续升高,而BE无显著升降趋势。存活组与死亡组TNF-α均呈早期上升,第3天达到峰值水平,之后呈下降趋势;两组IL-10均逐渐升高,第5天达峰后存活组下降而死亡组无明显下降。两组比较,除LAC、BE第1天差异无统计学意义外,其余各时间点死亡组P[A-a]O2、LAC、BE、TNF-α、IL-10均显著高于存活组(P<0.05)。相关关系比较:死亡组P[A-a]O2/TNF-α第5、7天、存活组BE/TNF-α第7天无显著相关关系,其余各时间点氧供氧耗指标P[A-a]O2、LAC、BE与促炎抗炎指标TNF-α、IL-10均有良好相关关系。结论严重脓毒症患者氧供氧耗失衡与促炎抗炎失衡有显著性相关关系,互为因果,恶性循环,经临床积极治疗P[A-a]O2、LAC、BE、TNF-α、IL-10显著下降者预后良好,反之则预后不良。Objective To study the relationship among P[A-a]O2、LAC、BE and Pro-and anti-inflammatory cytokines(TNF-α,IL-10)in severe sepsis patients,and to assess the significance for clinical condition.Methods From January 2014 to January 2016,50 severe sepsis patients which were received in EICU were divided into the survival group and the death group.Measure target:on the first,third,fifth and seventh day,serum of 50 patients were collected.Serum TNF-αand IL-10 levels were analyzed by ELISA,and P[A-a]O2,LAC、BE values were measured from blood gas analysis.Results The survival group P[A-a]O2 reached the peak level at the third day and decreased quickly,but the death group P[A-a]O2 kept increasing.In the survival group,LAC and BE reached the peak level at the first day and decreased to normal quickly.In the death group,LAC raised steadily,whereas there was no clear rising and falling trend of BE.Both of the groups TNF-αwere raised in early phase,and the third day reached the peak level,then gradual declined;The peak level of IL-10 were appeared at the fifth day,and then declined for the survival group while the death group held for high level.Correlation comparison:all of the P[A-a]O2,LAC,BE with TNF-α,IL-10 were significant positive correlation in every time point except the fifth,the seventh day of P[A-a]O2/TNF-αin the death group and the seventh day of BE/TNF-αin the survival group.Conclusion The imbalance of oxygen supply and demand with imbalance of inflammation and anti-inflam-mation for severe sepsis patients were significantly correlated,which decreased after the clinical treatment,indi-cates good prognosis,and those rised steadly or without decreased indicates poor prognosis.

关 键 词：严重脓毒症 肺泡-动脉氧分压差 血乳酸 碱剩余 炎症因子 多器官功能障碍综合征 

分 类 号：R459.7[医药卫生—急诊医学]