通过肺泡内蛋白质检测评判机械通气患者适用的支气管-肺泡灌洗量  

Detection of alveolar proteins evaluates the optimal bronchoalveolar lavage volume for mechanically ventilated patients

作　　者：梁丽群 韦碧琳 郑慧芳 顾彬 裴飞[1] 陈敏英[1] 吴健锋[1] LIANG Li-qun;WEI Bi-lin;ZHENG Hui-fang;GU Bin;PEI Fei;CHEN Min-ying;WU Jian-feng(Department of Critical Care Medicine,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510080,China)

机构地区：[1]中山大学附属第一医院重症医学科,广东广州510080

出　　处：《热带医学杂志》2020年第2期168-172,共5页Journal of Tropical Medicine

基　　金：广东省自然科学基金(2016A030313269);高校基本业务青年培育项目(15ykpy14)。

摘　　要：目的通过肺泡内蛋白质的检测探索机械通气患者进行支气管-肺泡灌洗(BAL)时合适的灌洗量。方法采用自身对照的研究方法,纳入2018年12月至2019年4月入住中山大学附属第一医院重症医学科并进行支气管-肺泡灌洗检查的机械通气患者。入组的患者给予室温生理盐水20 m L灌洗右主支气管和20 mL生理盐水×5次灌洗右肺中叶段/亚段支气管,分别单独收集支气管肺泡灌洗液(BALF)并分析各BALF中肺泡表面活性物质相关蛋白B(SP-B)、肺泡表面活性物质相关蛋白D(SP-D)和人Ⅰ型蛋白(HTⅠ-56)的含量。同时,观察BAL前后患者呼吸功能和血流动力学监测指标并记录患者的不良反应。结果共纳入11例患者,仅1例患者在BAL操作后出现呼吸系统不良反应(氧合指数下降>25%)。分析BALF发现:第3次肺段灌洗的单次回收率(47%)较第1次肺段灌洗(30%)和第2次肺段灌洗(36%)明显增加,差异有统计学意义(P<0.05);主支气管灌洗液以及第1次和第2次的肺段灌洗液中几乎不含SP-B、SP-D、HTⅠ-56;在第3、4、5次的肺段灌洗液中均可检测到这3种蛋白质[SP-B(pg/mL):(67.52±9.76)vs.(74.52±8.44)vs.(69.11±11.59);SP-D(ng/mL):(64.93±9.16)vs.(69.30±11.25)vs.(69.78±8.91);HTⅠ-56(pg/mL):(313.74±40.71)vs.(327.64±38.65)vs.(335.80±41.80)],且差异均无统计学意义(P>0.05)。结论肺泡内物质的检测显示60 mL生理盐水分3次灌洗可能是机械通气患者适用的支气管-肺泡灌洗量。Objective To investigate the optimal bronchoalveolar lavage volume for mechanically ventilated patients.Methods A self-control study was conducted. Mechanically ventilated patients who underwent bronchoalveolar lavage(BAL)in the Department of Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University from December in 2018 to April in 2019 were included. An initial 20 mL saline was instilled into the right main bronchus,followed by 5 aliquots of 20 mL saline instilled into a subsegment of the right middle lobe. Separately processed and analyzed aliquots for recovery ratio and the concentration of surfactant protein-B(SP-B),surfactant protein-D(SP-D)and Human type Ⅰprotein(HTⅠ-56). The respiratory and haemodynamic parameters of participants were monitored before and after BAL.Results A total of 11 patients were included and only one case of respiratory instability(a decrease in PaO2/FiO2 ratio>25%) was observed. Bronchoalveolar lavage fluid(BALF) analysis showed that there was a significant rise in BALF recovery ratio of the third subsegment lavage fluid(47%),compared with the first(30%)and the second(36%). SP-B,SP-D and HTⅠ-56 barely existed in the main bronchial lavage fluid as well as in the first and the second subsegment lavage fluid while they could be detected in the last three subsegment lavage fluid[SP-B(pg/mL):(67.52±9.76)vs.(74.52±8.44)vs.(69.11±11.59);SP-D(ng/mL):(64.93±9.16)vs.(69.30±11.25)vs.(69.78±8.91);HTⅠ-56(pg/mL):(313.74±40.71)vs.(327.64±38.65)vs.(335.80±41.80)]. Besides,the differences of SP-B,SP-D and HTⅠ-56 levels among the last three subsegment lavage fluid were not statistically significant. Conclusion The detection of alveolar proteins indicated that 60 mL might be the optimal bronchoalveolar lavage volume for mechanically ventilated patients.

关 键 词：支气管-肺泡灌洗 SP-B SP-D HTⅠ-56 

分 类 号：R454.4[医药卫生—治疗学]