摘要
目的通过测定急性呼吸窘迫综合征(A RDS)患者血浆及肺泡灌洗液白细胞介素6(IL-6)水平,比较气道压力释放通气(APRV)与小潮气量机械通气(LTV)对ARDS患者呼吸机相关性肺损伤影响的程度.方法本研究采用前瞻性随机交叉实验设计,对入选ARDS病例随机分为2组,LTV组先予APRV通气12 h,再转为LTV 12 h;APRV组先予L T V通气12 h,再转为A PRV 12 h,比较实验开始0、1、12、13、24 h血浆IL-6水平及0、12、24 h肺泡灌洗液IL-6水平.结果 A PRV转为L T V后12 h血浆IL-6水平从(54.92±42.44)ng/L上升至(69.74±41.11)ng/L(t=2.32,P=0.01);肺泡灌洗液IL-6水平由(71.17±56.47)ng/L上升至(91.25±46.56)ng/L(P>0.05).A PRV组转换通气模式后12 h血浆IL-6水平由(72.56±37.59)ng/L下降至(60.92±44.06)ng/L(P>0.05);肺泡灌洗液IL-6水平由(123.63±41.64)ng/L下降至(107.41±17.20)ng/L(P>0.05).2组IL-6浓度转换模式12 h前后的差值(24 h与12 h的差值比12 h与0 h的差值)比较,差异有统计学意义(t=1.34,P=0.03).结论 ARDS患者APRV模式较LTV模式血浆IL-6水平下降.
Objective To compare the effects of airway pressure release ventilation ( APRV) and low tidal volume mechanical ventilation ( LTV) on ventilator-associated lung injury in acute respiratory distress syndrome ( ARDS) patients by measuring the plasma and alveolar lavage fluid interleukin-6 ( IL-6) levels .Methods It is a randomized crossover study .Patients meet ARDS criteria were divided into 2 groups randomly .LTV group were treated with APRV first ,12 hours later switched to LTV ,APRV group were treated with LTV first , 12 hours later switched to APRV .The plasma IL-6 levels at 0 ,1 ,12 ,13 and 24h and the IL-6 levels in 0 ,12 and 24h alveolar lavage fluid were compared .Results 12 hours after APRV convert to LTV ,the IL-6 in serum rise from (54 .92 ± 42 .44) ng/L to (69 .74 ± 41 .11) ng/L( t =2 .32 , P =0 .01);the IL-6 in alveolar lavage fluid rise from ( 71 .17 ± 56 .47) ng/L to ( 91 .25 ± 46 .56) ng/L ( P >0 .05) .12 hours after LTV convert to APRV ,the IL-6 in serum declined from ( 72 .56 ± 37 .59) ng/L to ( 60 .92 ± 44 .06) ng/L ( P >0 .05);the IL-6 in alveolar lavage fluid rise from ( 123 .63 ± 41 .64) ng/L to ( 107 .41 ± 17 .20) ng/L( P > 0 .05) .The difference of IL-6 concentration before and after 12 h in the two groups ( the difference between 24 h and 12 h vs the difference between 12 h and 0 h) was statistically significant ( t =1 .34 , P =0 .03) .Conclusions APRV alleviates IL-6 level in serum of ARDS compared with the LTV .
作者
李瑞
徐志育
王华杰
谢晓红
Li Rui;Xu Zhiyu;Wang Huajie;Xie Xiaohong(Department of Critical Care Medicine, Hainan Provincial People' s Hospital, Haikou 570000,China)
出处
《国际呼吸杂志》
2019年第18期1385-1390,共6页
International Journal of Respiration
关键词
呼吸机所致肺损伤
白细胞介素6
呼吸窘迫综合征
成人
气道压力释放通气
Ventilator-induced lung injury
Interleukin-6
Respiratory distress syndrome,adult
A irw ay pressure release ventilation
