结构脂肪乳对急性肺损伤患者早期炎性反应和呼吸功能的影响  

Effect of structural lipid emulsion on early inflammatory response and respiratory function of patients with acute lung injury

作　　者：孙海云 SUN Haiyun(Heze Municipal Hospital,Heze 274000,Shandong)

机构地区：[1]菏泽市立医院,山东菏泽274000

出　　处：《菏泽医学专科学校学报》2020年第2期19-22,共4页Journal of Heze Medical College

摘　　要：目的探讨结构脂肪乳对急性肺损伤(ALI)患者早期炎性反应和呼吸功能的影响。方法将60例ALI患者按随机数字表法分为观察组和对照组,每组30例。两组患者除常规治疗外,均给予等热量、等氮量的营养支持。观察组给予结构脂肪乳250 ml,对照组给予中长链脂肪乳250 ml,疗程7天,分别于治疗前及治疗第7 d进行动脉血气分析、支气管肺泡灌洗液(BALF)和血清中炎性介质肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、C反应蛋白(CRP)以及抗炎因子脂联素(APN)的检测等。比较两组患者外周血T细胞亚群(CD3^+、CD4^+、CD8^+、CD4^+/CD8^+)及BALF和外周血中IgG、IgA、IgM。同时记录急性生理学及慢性健康状况(APACHEⅡ)评分、氧合指数、机械通气时间。结果两组患者治疗后BALF、TNF-α、IL-1β、IL-6、CRP较治疗前均有不同程度下降,APN有不同程度升高;与对照组相比,观察组BALF、TNF-α、IL-1β、IL-6、CRP下降明显,APN升高显著(P<0.01);同时观察组患者免疫功能改善明显(P<0.01)。观察组较对照组,氧合指数改善,机械通气时间缩短(P<0.01)。结论结构脂肪乳可减轻ALI患者炎性反应,改善免疫功能,增加气体交换,进而提高动脉血氧合,缩短机械通气时间。Objective To explore the effect of structural lipid emulsion on early inflammatory response and respira⁃tory function of acute lung injury(ALI)patients.Methods 60 patients with ALI were randomly divided into the control group and the observation group.Except for the routine therapy for ALI,all patients received nutritional support therapy of equal caloric and nitrogen content.The observation group were given 250 ml structural lipid emulsion,meanwhile the con⁃trol group was treated with 250 ml medium and long-chain lipid emulsion for 7 days.The artery blood gas analysis,bron⁃choalveolar lavage fluid(BALF)and the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),C-reactive protein(CRP)and anti-inflammatory factor adiponectin(APN)were measured before treatment and 7 days after treatment.The peripheral T cell subsets(CD3^+,CD4^+,CD8^+,CD4^+/CD8^+)and the LgG,lgA and lgM in BALF and peripheral blood were compared.During the period of treatment,APACHEⅡscore,oxygenation index and the duration of mechanical ventilation were recorded.Results The levels of BALF,TNF-α,IL-1β,IL-6 and CRP in the two groups were all decreased than those before treatment;while the level of APN increased than that before the treatment(P<0.01).Compared with the control group,the levels of BALF,TNF-α,IL-1β,IL-6 and CRP in the observation group decreased more significantly;while the level of APN increased more significantly(P<0.01).The oxygenation index and the duration of mechanical ventilation in the observation group improved more significantly(P<0.01).Conclusion The structural lip⁃id emulsion can dimishes inflammatory response,improve immune function and oxygenation index and shorten the period of ventilation.

关 键 词：结构脂肪乳 急性肺损伤 炎性反应 免疫功能 呼吸功能 

分 类 号：R563.8[医药卫生—呼吸系统]