呼出气冷凝液sRAGE对髋关节置换术后发生呼吸机所致肺损伤的预测价值  

Value of exhaled condensate sRAGE to the prediction of ventilator-induced lung injury after hip arthroplasty

作　　者：陈洁[1] 孙晶晶 顾小萍[1] 马正良[1] 李冰冰[1] CHEN Jie;SUN Jing-jing;GU Xiao-ping;MA Zheng-liang;LI Bing-bing(Depurtment of Anesthesiology,Drum Tmver Hospital,Medical College of Nanjing,University,Nanjing,Jiangsu 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,江苏南京210008

出　　处：《中华实用诊断与治疗杂志》2021年第7期723-727,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：江苏省六大人才高峰项目(2016-WSN-147);南京市青年卫生人才项目(QRX17013)。

摘　　要：目的观察髋关节置换术机械通气期间呼出气冷凝液可溶性晚期糖基化终末产物受体(soluble receptor for advanced glycation end-products, sRAGE)水平变化,探讨其与髋关节置换术后发生呼吸机所致肺损伤的关系。方法行髋关节置换术患者64例,术中机械通气采用容量控制模式,根据术后是否发生呼吸机所致肺损伤分为损伤组和未损伤组。比较2组年龄、性别、ASA分级等一般资料;收集2组麻醉诱导气管插管后1、2 h时呼出气冷凝液及动脉血,采用ELISA法检测呼出气冷凝液表面活性蛋白-D(surfactant protein-D, SP-D)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)水平,血浆sRAGE及血清SP-D、TNF-α水平,并进行比较;多因素logistic回归分析髋关节置换术后发生呼吸机所致肺损伤的影响因素;绘制ROC曲线,评估气管插管2 h时呼出气冷凝液sRAGE预测髋关节置换术后发生呼吸机所致肺损伤的价值。结果 64例患者呼吸机所致肺损伤发生率为17.19%。损伤组年龄[(75.00±6.36)岁]大于未损伤组[(66.19±12.01)岁](P<0.05),男性比率(9.09%)低于未损伤组(43.40%)(P<0.05),ASA分级、合并症与未损伤组比较差异均无统计学意义(P>0.05)。损伤组气管插管2 h时呼出气冷凝液sRAGE水平[(66.81±8.69) ng/L]高于未损伤组[(50.46±10.36) ng/L](P<0.05),气管插管1 h时呼出气冷凝液sRAGE水平及气管插管1、2 h时呼出气冷凝液SP-D、TNF-α水平与未损伤组比较差异均无统计学意义(P>0.05);损伤组气管插管2 h时呼出气冷凝液sRAGE水平高于气管插管1 h时[(51.82±12.13) ng/L](P<0.05),SP-D、TNF-α水平与气管插管1 h时比较差异均无统计学意义(P>0.05);未损伤组气管插管2 h时呼出气冷凝液sRAGE、SP-D、TNF-α水平与气管插管1 h时比较差异均无统计学意义(P>0.05)。损伤组气管插管1、2 h时血浆sRAGE及血清SP-D、TNF-α水平与未损伤组比较差异均无统计学意义(P>0.05);损伤组、未损伤组气管插管2Objective To observe the changes of plasma soluble receptor for advanced glycation end-products(sRAGE)in exhaled condensate during mechanical ventilation in patients undergoing hip arthroplasty,and to investigate its relationship with ventilator-induced lung injury(VILI).Methods Sixty-four patients undergoing hip arthroplasty were divided into VILI group and no-VILI group according to whether VILI occurred after operation.Intraoperative mechanical ventilation was performed in volume control mode.The general data as age,gender and ASA grade were compared between two groups.The exhaled condensate and arterial blood were collected 1 and 2 h after anesthesia-induced endotracheal intubation in two groups.The levels of exhaled condensate surfactant protein-D(SP-D),exhaled condensate tumor necrosis factor-α(TNF-α),plasma sRAGE,serum SP-D and serum TNF-αwere detected by ELISA and compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of VILI after hip arthroplasty.ROC curve was drawn to evaluate the values of exhaled condensate sRAGE 2 h after endotracheal intubation to the prediction of VILI after hip arthroplasty.Results The incidence of VILI was 17.19%.The patients were older in VILI group((75.00±6.36)years)than in no-VILI group((66.19±12.01)years)(P<0.05).The male ratio was lower in VILI group(9.09%)than that in no-VILI group(43.40%)(P<0.05),and there were no significant differences in ASA grade and complications between two groups(P>0.05).The exhaled condensate sRAGE 2 hafter endotracheal intubation was higher in VILI group((66.81±8.69)ng/L)than that in no-VILI group((50.46±10.36)ng/L)(P<0.05).The levels of exhaled condensate sRAGE 1 hafter endotracheal intubation,and the levels of exhaled condensate SP-D and TNF-α1 and 2 hafter endotracheal intubation showed no significant differences between two groups(P>0.05).The level of exhaled condensate sRAGE 2 hafter endotracheal intubation was higher than that 1 hafter endotracheal intubation((51.82±12.13)ng/L)(P<0.

关 键 词：髋关节置换术 呼吸机所致肺损伤 呼出气冷凝液 可溶性晚期糖基化终末产物受体 表面活性蛋白-D 肿瘤坏死因子-α 

分 类 号：R563[医药卫生—呼吸系统] R687.4[医药卫生—内科学]