不同光照方式对重症AECOPD患者血清褪黑素及氧化应激水平的影响  

Influence on levels of melatonin and oxidative stress in critically ill patients with AECOPD treated by different ways of light

作　　者：盖美华 富燕萍[2] 金艾香[1] 姚惠萍[2] GAI Mei-hua;FU Yan-ping;JIN Ai-xiang;YAO Hui-ping(Department of Head and Neck Thyroid Surgery,Zhejiang Provincial People's Hospital/People's Hospital Affiliated Hangzhou Medical College,Hangzhou,Zhejiang 310014,China;不详)

机构地区：[1]浙江省人民医院/杭州医学院附属人民医院头颈甲状腺外科,浙江杭州3100141 [2]浙江省人民医院/杭州医学院附属人民医院重症医学科

出　　处：《中华全科医学》2022年第10期1662-1665,共4页Chinese Journal of General Practice

基　　金：浙江省医药卫生科技计划项目(2020KY444)。

摘　　要：目的探讨不同光照方式对重症慢性阻塞性肺疾病急性加重期(AECOPD)患者血清褪黑素(Mel)及氧化应激水平的影响。方法选取浙江省人民医院ICU 2019年7月—2020年12月收治的100例AECOPD患者为研究对象,按照随机数字表法分为对照组(48例)和观察组(52例)。对照组给予24 h不间断光照,观察组采用间断光照方式。检测2组血清Mel、尿6-磺酸基褪黑素(6-SMT)、肺泡灌洗液(BALF)中丙二醛(MDA)及超氧化物歧化酶(SOD)水平并进行统计学分析。结果观察组和对照组血清Mel(早上7点及晚上10点)在入院后第5天分别为(29.6±5.8)pg/mL、(26.7±6.4)pg/mL和(50.8±8.5)pg/mL、(46.7±9.1)pg/mL,入院后第10天分别为(35.3±8.2)pg/mL、(24.5±5.7)pg/mL和(55.6±6.6)pg/mL、(44.5±7.5)pg/mL。与对照组相比,观察组血清Mel(早上7点及晚上10点)水平均呈现出逐渐升高趋势(均P<0.05)。2组尿6-SMT(早上7点及晚上10点)水平也呈现出相似趋势。观察组BALF中MDA水平逐渐下降而SOD水平逐渐升高(均P<0.05)。与对照组相比观察组撤机成功率明显升高,而ICU停留时间、MODS发生率和28天病死率均明显降低(均P<0.05)。结论对重症AECOPD患者实施间断光照能够明显提高患者体内褪黑素及其代谢产物水平,提高抗氧化应激能力,改善预后。Objective To discuss the influence on levels of melatonin(Mel)and oxidative stress in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)treated by different ways of light.Methods One hundred patients with AECOPD admitted to the Intensive Care Unit(ICU)of Zhejiang Province People's Hospital from July 2019 to December 2020 were selected as study subjects and divided into the control group(n=48)and observation group(n=52)according to random number table.The patients of control group were given 24-hour illumination,while the patients of observation group were given intermittent light way.The levels of serum Mel and urine 6-sulfonic melatonin(6-SMT),malondialdehyde(MDA)and superoxide dismutase(SOD)in bronchoalveolar lavage fluid(BALF)were measured,and statistical analysis were carried out.Results The levels of serum Mel(7 a.m.and 10 p.m.)were(29.6±5.8)pg/mL,(26.7±6.4)pg/mL and(50.8±8.5)pg/mL,(46.7±9.1)pg/mL respectively at 5 days after admission.The levels of serum Mel(7 a.m.and 10 p.m.)were(35.3±8.2)pg/mL,(24.5±5.7)pg/mL and(55.6±6.6)pg/mL,(44.5±7.5)pg/mL respectively at 10 days after admission.Compared with the control group,the levels of serum Mel(7 a.m.and 10 p.m.)in the observation group showed a gradually increasing trend(all P<0.05).The levels of urine 6-SMT(7 a.m.and 10 p.m.)in the two groups showed a similar trend.In the observation group,the level of MDA in BALF gradually decreased while the level of SOD gradually increased(all P<0.05).The success rate of removing ventilator of the observation group was obviously higher than that of the control group,while ICU stay time,the incidence of MODS and 28-day mortality were lower than those of the control group(all P<0.05).Conclusion For critically ill patients with AECOPD,intermittent illumination can obviously increase the level of melatonin and its metabolites in the body,improve the ability of resistance to oxidative stress and improve prognosis.

关 键 词：慢性阻塞性肺疾病急性加重期 光照方式 褪黑素 氧化应激 

分 类 号：R563[医药卫生—呼吸系统]