摘要
目的通过测定机械通气对急性呼吸窘迫综合征(Acute Respiratory Distress Syndrome,ARDS)患者支气管肺泡灌洗液(BronchoAlveolar Lavage Fluid,BALF)与血清中肺损伤标记物的变化,明确气道压力释放通气(Airway Pressure Release Ventilation,APRV)与小潮气量保护性通气(Low Tidal Volume Protective Ventilation,LTV)对ARDS患者呼吸机相关性肺损伤(Ventilator-Induced Lung Injury,VILI)的影响。方法收集深圳大学总医院及海南省人民医院2018-01至2019-05内ARDS住院患者40例,以随机数字法分为两组:A组21例,B组19例,A组先予APRV通气24 h,随后转为LTV 24 h;B组先予LTV 24 h,再转为APRV 24 h,比较干预治疗0 h、24 h、48 h两组患者氧合指数、呼吸力学、BALF及血清中肺泡表面活性蛋白(Pulmonary Surfactant Protein D,SP-D)、重组人晚期糖基化终末产物特异性受体(SolubleReceptor for Advanced Glycation end Products,sRAGE)、血管内皮生长因子(Vascular Endothlial Growth Factor,VEGF)、促血管生成素-2(Angiopopietin-2,Ang-2)浓度的变化。结果两组各监测时间点、氧合指数与气道平均压比较差异无统计学意义(P>0.05);干预治疗24 h,A组患者BALF中SP-D浓度高于B组(359.6±80.5μg/L vs 296.2±82.5μg/L),sRAGE浓度低于B组(2113.0±374.2 ng/L vs2358.1±337.3 ng/L),两组比较具有统计学意义(P<0.05);两组患者VEGF和Ang-2浓度比较,差异无统计学意义(P>0.05);同时,A组患者治疗24 h血清中SP-D浓度低于同一时间段B组(101.4±26.4μg/L VS 158.4±34.1μg/L,P<0.05),但两组患者血清中sRAGE、VEGF、Ang-2浓度差异无统计学意义(P>0.05)。A组干预治疗48 h,患者BALF中SP-D值较24 h下降(359.6±80.5μg/L vs 211.9±74.7μg/L,P<0.05),sRAGE值升高(2113.0±374.2ng/L vs 2833.7±488.0 ng/L,P<0.05);血清中SP-D值(101.4±26.4μg/L vs 160.8±23.7μg/L,P<0.05)和sRAGE值升高(829.0±192.7 ng/L vs 1070.3±245.5 ng/L,P<0.05)。B组干预治疗48h,患者BALF中SP-D值较24 h升高(296.2±82.5μg/L vs 331.9±92.1μg/L,P<0.05),sRAGE值下降(2358.1±337.3 ng/L vs2090.9±288.1 ng/L,P<0.05);血清中SP-D值(158.4±34.1μg/L vs 136.6±50.8μg/L,P<0.05)和sRAGE值下降(896.1±215.4ng/L vs 782.0±245.7 ng/L,P<0.05);VEGF与Ang-2值变化均无统计学差异(P>0.05)。结论与LTV相比,APRV时BALF中SP-D浓度较高,sRAGE浓度较低,血清SP-D及sRAGE升高,提示APRV可能减少ARDS患者的VILI,为ARDS机械通气选择APRV通气模式提供依据。
Objective To investigate the effects of Airway Pressure Release Ventilation(APRV)and Low Tidal Volume Protective Ventilation(LTV)on Ventilator-Induced Lung Injury(VILI)in patients with Acute Respiratory Distress Syndrome(ARDS)by measuring the levels of lung injury biomarkers in Bronchoalveolar Lavage Fluid(BALF)and serum.Methods A total of 40 ARDS patients admitted to Shenzhen University General Hospital and Hainan Provincial People’s Hospital from January 2018 to May 2019 were selected as research subjects and divided into two groups randomly.Group A(n=21)were treated with APRV ventilation for 24 h,followed by LVT for another 24 h.Group B(n=19)were given LTV for the first 24 h and then converted to APRV for another 24 h.The change of oxygenation index,respiratory mechanics,Pulmonary Surfactant Protein-D(SP-D),Soluble Receptor for Advanced Glycation End Products(sRAGE),Vascular Endothelial Growth Factor(VEGF),and Angiopoietin-2(Ang-2)in BALF and serum were detected after treatment intervention for 0 h,24 h and 48 h.Results There was no significant difference in oxygenation index and mean airway pressure at each monitoring time point between the two groups(P>0.05).After 24 h of intervention,the SP-D concentration of BALF in group A was higher than that in group B(359.6±80.5μg/L vs 296.2±82.5μg/L,P<0.05),and the sRAGE concentration was lower than that in group B(2113.0±374.2 ng/L vs 2358.1±337.3 ng/L,P<0.05).There was no statistical difference in the concentrations of the VEGF and Ang-2 between the two groups(P>0.05).Meanwhile,the SP-D in serum of group A was lower than that of group B at 24 h(101.4±26.4μg/L vs 158.4±34.1μg/L,P<0.05),but no significant difference was found in the concentrations of sRAGE,VEGF,and Ang-2 in serum between the two groups(P>0.05).In group A,the BALF SP-D decreased(359.6±80.5μg/L vs 211.9±74.7μg/L,P<0.05)and the sRAGE increased(2113.0±374.2 ng/L vs 2833.7±488.0 ng/L,P<0.05)at 48 h compared with that at 24 h.The serum SP-D(101.4±26.4μg/L vs 160.8±23.7 g/L,P<0.05)and sRAGE(829.0±192.7 ng/L vs 1070.3±245.5 ng/L,P<0.05)concentration both increased at 48 h compared with that at 24 h;In group B,the BALF SP-D(296.2±82.5μg/L vs 331.9±92.1μg/L,P<0.05)increased and the sRAGE(2358.1±337.3 ng/L vs 2090.9±288.1 ng/L,P<0.05)decreased at 48 h compared with that at 24 h.The serum SP-D(158.4±34.1μg/L vs 136.6±50.8μg/L,P<0.05)and sRAGE(896.1±215.4 ng/L vs 782.0±245.7 ng/L,P<0.05)both decreased at 48 h compared with that at 24 h.There was no statistical significance in the change of VEGF and Ang-2(P>0.05).Conclusion Higher BALF SP-D,lower BALF sRAGE,and higher serum SP-D and sRAGE were seen in APRV than in LTV,suggesting that APRV may reduce VILI in ARDS patients,which could provide a basis for the selection of APRV ventilation mode for ARDS.
作者
李瑞
李琴
王玉珠
田佳
徐志育
韩伟
LI Rui;LI Qin;WANG Yuzhu;TIAN Jia;XU Zhiyu;HAN Wei(Emergency Department,Shenzhen University General Hospital,Shenzhen 518055,China;Department of Critical Medicine,Hainan Provincial People’s Hospital,Haikou 570311,China)
出处
《中华灾害救援医学》
2022年第2期61-66,共6页
Chinese Journal of Disaster Medicine
基金
深圳市医疗卫生三名工程项目(SZSM201911007)。
关键词
气道压力释放通气
呼吸机相关性肺损伤
肺表面活性蛋白D
重组人晚期糖基化终末产物特异性受体
急性呼吸窘迫综合征
Airway Pressure Release Ventilation(APRV)
Ventilator-Induced Lung Injury(VILI)
Pulmonary Surfactant Protein-D(SP-D)
Soluble Receptor for Advanced Glycation End Products(sRAGE)
Acute Respiratory Distress Syndrome(ARDS)
作者简介
通信作者:韩伟,Email:18813980300@139.com。
