摘要
目的探讨高频振荡通气联合乌司他丁对烟雾吸入性肺损伤后呼吸窘迫患者的血清炎症因子、血气指标、内皮功能的影响。方法选择2016年1月至2019年1月解放军联勤保障部队第九一〇医院收治因烟雾吸入性肺损伤所致急性呼吸窘迫综合征的入院患者62例作为研究对象。采用前瞻性队列研究方法,应用随机数字表将患者分为对照组31例和观察组31例。对照组患者给予高频振荡通气治疗,观察组在对照组的基础上再给予静脉泵入乌司他丁治疗,30万U/次,溶于50 ml生理盐水,每8小时1次。干预前、干预后48 h进行急性生理学与慢性健康状况评分系统(acute physiology and chronic health evaluation,APACHE)Ⅱ评分,采用酶联免疫吸附法检测血清白细胞介素6(interleukin-6,IL-6)、IL-8、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、一氧化氮、内皮素1,采用血气分析仪测定动脉氧分压(arterial blood oxygen partial pressure,PaO2)、二氧化碳分压(arterial partial pressure of CO2,PaCO2)、氧合指数,应用脉搏指示连续心排血量监测记录血管外肺水指数(extra-vascular lung water index,EVLWI)、肺毛细血管渗透性指数(pulmonary vascular permeability index,PVPI),记录不良反应发生情况。结果观察组干预48 h后IL-6[(66.8±15.2)ng/L]、IL-8[(70.3±10.4)ng/L、TNF-α[(24.6±3.5)ng/L]较干预前[(89.3±21.0)ng/L、(288.4±33.5)ng/L、(101.3±9.0)ng/L]显著下降,差异有统计学意义(t值分别为5.704、21.215、30.281,P均<0.05),且明显低于对照组[(90.4±22.4)ng/L、(162.4±16.6)ng/L、(62.3±4.4)ng/L],差异有统计学意义(t值分别为4.906、12.324、19.252,P均<0.05)。对照组和观察组干预48 h后氧合指数[(208.5±55.4)mmHg和(315.3±49.8)mmHg]、PaO2[(101.6±12.4)mmHg和(118.8±10.3)mmHg]较干预前[(114.8±24.6)mmHg和(112.3±20.5)mmHg,(70.6±10.5)mmHg和(70.3±10.2)mmHg]明显升高(t值分别为15.663和22.387、11.216和16.214,P均<0.05),PaCO2[(44.7±7.4)mmHg和(39.3±
Objective To investigate the influence of high frequency oscillatory ventilation combined with ulinastatin on serum inflammatory factors,blood gas indexes and endothelial function in patients with respiratory distress after smoke inhalation lung injury.Methods Sixty-two patients with acute respiratory distress syndrome induced by smoke inhalation lung injury from January 2016 to January 2019 in the 910th Hospital of the PLA Joint Service Support Unit were enrolled.With a prospective cohort study,the patients were divided into control group(31 cases)and observation group(31 cases)according to the random number table.The control group were treated with high-frequency oscillatory ventilation.The observation group was given intravenous ulinastatin treatment on the basis of the control group,3×105 U/time,dissolved in 50 ml of normal saline,once every 8 hours.Acute physiology and chronic health evaluation(APACHE)Ⅱscore was performed before intervention and 48 hours after intervention.Serum interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),nitric oxide,endothelin-1 were detected by enzyme-linked immunosorbent assay.Arterial blood oxygen partial pressure(PaO2),arterial partial pressure of carbon dioxide(PaCO2),oxygenation index were measured by blood gas analyzer.The Extra-vascular lung water index(EVLWI),pulmonary vascular permeability index(PVPI)were recorded by pulse indicator continuous cardiac output monitoring.The occurrence of adverse reactions were recorded.Results The IL-6((66.8±15.2)ng/L),IL-8((70.3±10.4)ng/L,TNF-α((24.6±3.5)ng/L)of the observation group after treatment 48 hours were lower than before treatment((89.3±21.0)ng/L,(288.4±33.5)ng/L,(101.3±9.0)ng/L),the difference was statistically significant(t value was 5.704,21.215,30.281,repectively,all P<0.05),and the observation group were significantly lower than the control group((90.4±22.4)ng/L,(162.4±16.6)ng/L,(62.3±4.4)ng/L),the difference was statistically significant(t value was 4.906,12.324,19.252,repectively,all P<0.
作者
黄鑫成
杨秋玲
金润女
洪丽月
洪原城
Huang Xincheng;Yang Qiuling;Jin Runnv;Hong Liyue;Hong Yuancheng(Department of Respiratory Medicine,the 910th Hospital of the PLA Joint Service Support Unit,Quanzhou 362000,China)
出处
《中国综合临床》
2020年第4期347-352,共6页
Clinical Medicine of China
基金
泉州市科技计划项目(2017Z019)。
关键词
烟雾吸入性肺损伤
高频振荡通气
乌司他丁
急性呼吸窘迫
Smoke inhalation lung injury
High frequency oscillatory ventilation
Ulinastatin
Acute respiratory distress
