氦氧机械通气对肺炎患者病变肺段炎症反应及膈肌功能的影响  

Effects of helium-oxygen mechanical ventilation on inflammatory response of diseased lung segments and diaphragm function in patients with pneumonia

作　　者：任德才 周丽丽 郑承庆 谢善敏 余然杰 Ren Decai;Zhou Lili;Zheng Chengqing;Xie Shanmin;Yu Ranjie(Department of Critical Care Medicine,Pingtan Comprehensive Experimental Area Hospital,Pingtan 350400,Fujian,China;Department of Critical Care Medicine,Fujian Medical University Union Hospital,Fuzhou 350401,Fujian,China)

机构地区：[1]平潭综合实验区医院重症医学科,福建平潭350400 [2]福建医科大学附属协和医院重症医学科,福州350401

出　　处：《中华危重病急救医学》2024年第3期260-265,共6页Chinese Critical Care Medicine

基　　金：福建省科技计划社会发展引导性(重点)项目(2022Y0020)。

摘　　要：目的探讨氦氧机械通气对肺炎所致急性呼吸窘迫综合征(ARDS)停机困难患者的病变肺段炎症反应及膈肌功能的临床作用。方法采用前瞻性对照研究方法,选择2020年10月至2021年12月福建医科大学附属协和医院平潭分院重症医学科收治的40例因肺炎所致ARDS需气管插管的停机困难患者。将患者按随机数字表法分为氮氧通气组和氦氧通气组,每组20例。氮氧通气组给予60%氮气、40%氧气通气治疗,氦氧通气组给予60%氦气、40%氧气通气治疗。收集各组患者通气治疗0、1、2、3 h肺机械通气参数〔气道峰压(Ppeak)、气道平台压(Pplat)、潮气量(VT)、每分钟通气量(MV)〕及脉搏血氧饱和度(SpO_(2));同时,在通气治疗前及治疗3 h后,检测患者病变肺段肺泡上皮细胞衬液中炎症因子白细胞介素-6(IL-6)、C-反应蛋白(CRP)水平,测量膈肌运动幅度和膈肌厚度变化率。结果两组患者的性别、年龄、氧合指数、血清CRP、血清降钙素原(PCT)、体温、血肌酐(SCr)、丙氨酸转氨酶(ALT)、空腹血糖(FPG)、血红蛋白(Hb)以及心脏和肺部基础疾病情况等基线资料比较差异均无统计学意义。在控制VT和SpO_(2)相对不变的情况下,氦氧通气组通气1 h气道压即较通气前明显下降〔Ppeak(cmH_(2)O,1 cmH_(2)O≈0.098 kPa):22.80±4.47比28.00±5.07,Pplat(cmH_(2)O):19.15±3.90比23.20±3.81,均P<0.05〕,而氮氧通气组通气1 h气道压较通气前明显上升〔Ppeak(cmH_(2)O):22.35±2.13比19.75±1.94,Pplat(cmH_(2)O):18.50±1.70比16.50±1.88,均P<0.05〕。氮氧通气组通气前后病变肺段肺泡上皮细胞衬液CRP和IL-6水平比较差异均无统计学意义,而氦氧通气组通气后上述指标水平均较通气前明显降低,且显著低于氮氧通气组〔CRP(mg/L):10.15(6.39,15.84)比16.10(11.63,18.66),IL-6(μg/L):1.15(0.78,1.86)比2.67(1.67,4.85),均P<0.05〕。氮氧通气组通气前后膈肌运动幅度和膈肌厚度变化率比较差异均无统计学意�Objective To investigate the clinical effect of helium-oxygen mechanical ventilation on inflammation of the diseased lung segment and diaphragm function in patients with acute respiratory distress syndrome(ARDS)caused by pneumonia who suffered difficulty weaning from mechanical ventilation.Methods A prospective controlled study was conducted.A total of 40 patients with ARDS caused by pneumonia and requiring tracheal intubation with difficulty weaning from mechanical ventilation,admitted to the department of critical care medicine in Pingtan Branch of Fujian Medical University Union Hospital from October 2020 to December 2021 were enrolled.Patients were divided into nitrogen oxygen ventilation group and helium-oxygen ventilation group according to random number table,with 20 cases in each group.The nitrogen oxygen ventilation group was given 60%nitrogen and 40%oxygen ventilation treatment,and the helium-oxygen ventilation group was given 60%helium and 40%oxygen ventilation treatment.Peak airway pressure(Ppeak),plateau airway pressure(Pplat),tidal volume(VT),minute ventilation volume(MV)and pulse oxygen saturation(SpO_(2))were collected at 0,1,2,3 hours after ventilation treatment.At the same time,the concentrations of inflammatory factors interleukin-6(IL-6)and C-reactive protein(CRP)in epithelial lining fluid in patients with diseased lung segments were measured before and after ventilation treatment for 3 hours,and the diaphragmatic excursion and the diaphragmatic thickening fraction were measured before and after ventilation treatment for 3 hours.Results There were no significant differences in gender,age,oxygenation index,serum CRP,serum procalcitonin(PCT),body temperature,serum creatinine(SCr),alanine aminotransferase(ALT),fasting blood glucose(FPG),hemoglobin(Hb),and basic heart and lung diseases between the two groups.Under the condition that VT and SpO_(2) are relatively unchanged,the airway pressure in helium-oxygen ventilation group decreased significantly after 1 hour of ventilation[Ppeak(cmH_(2)O,1 cmH

关 键 词：肺炎 急性呼吸窘迫综合征 氦氧机械通气 炎症因子 膈肌功能 

分 类 号：R563.1[医药卫生—呼吸系统]