【摘要】 目的探讨急性呼吸窘迫综合征(ARDS)机械通气患者呼出气冷凝液(EBC)中过氧化氢(H2O2)和白介素6(IL-6)水平变化及其临床意义。方法选取2012年9月—2013年12月贵阳医学院附属医院内科重症监护病房(MICU)收治的ARDS患者42例,均经气管插管或气管切开进行机械通气治疗。按患者入住MICU两周后转归分为存活组22例和死亡组20例,比较两组患者机械通气后1、3、5、7 d急性生理学及慢性健康状况(APACHE)Ⅱ评分、APACHEⅢ评分及EBC中H2O2、IL-6水平,分析两组患者机械通气后1、3、5、7 d APACHEⅡ评分、APACHEⅢ评分与EBC中H2O2、IL-6水平的相关性。结果 (1)存活组患者机械通气后3、5、7 d EBC中H2O2和IL-6水平低于机械通气后1 d,死亡组患者机械通气后7 d EBC中H2O2和IL-6水平高于机械通气后1、3、5 d(P<0.05)。(2)机械通气后1 d两组患者APACHEⅡ和APACHEⅢ评分比较,差异无统计学意义(P>0.05);机械通气后3、5、7 d死亡组患者APACHEⅡ和APACHEⅢ评分高于存活组(P<0.05)。(3)械通气后1、3 d两组患者EBC中H2O2和IL-6水平比较,差异无统计学意义(P>0.05);机械通气后5、7 d死亡组患者EBC中H2O2和IL-6水平均高于存活组(P<0.05)。(4)存活组患者机械通气后不同时间点EBC中H2O2和IL-6水平与APACHEⅡ和APACHEⅢ评分间无直线相关关系(P>0.05);死亡组患者机械通气后5、7 d EBC中H2O2水平与APACHEⅡ和APACHEⅢ评分呈正相关,EBC中IL-6水平与APACHEⅡ和APACHEⅢ评分呈负相关(P<0.05)。结论 ARDS机械通气患者EBC中H2O2和IL-6水平均升高,且与病情严重程度相关,其可作为气道炎性反应的监测指标,结合APACHE评分可为评估患者预后提供参考。更多还原

【Abstract】 Objective To investigate the changes and clinical significances of hydrogen peroxide( H2O2) and interleukin- 6( IL- 6) levels in exhaled breath condensate( EBC) of patients with acute respiratory distress syndrome( ARDS) treated with mechanical ventilation. Methods From September 2012 to December 2013,a total of 42 patients with ARDS treated with mechanical ventilation were selected in MICU, the Second People’ s Hospital of Guiyang, and they were divided into survival group( n = 22) and death group( n = 20) according to 2- week prognosis after admission of MICU. APACHEⅡ score,APACHEⅢ score,H2O2 and IL- 6 levels in EBC were compared between the two groups after 1 day,3 days,5 days,7 days of mechanical ventilation,and their correlations were analyzed. Results H2O2 and IL- 6 levels in EBC after 3 days,5 days,7 days of mechanical ventilation of survival group were lower than those after 1 day of mechanical ventilation,respectively; while H2O2 and IL- 6 level in EBC after 7 days of mechanical ventilation of death group were higher than those after 1 day, 3 days, 5 days of mechanical ventilation, respectively( P < 0. 05). No statistically significant differences of APACHEⅡ score or APACHEⅢ score was found between the two groups after 1 day of mechanical ventilation( P> 0. 05); while APACHEⅡ score and APACHEⅢ score of death group were higher than those of survival group after 3 days,5days,7 days of mechanical ventilation,respectively( P < 0. 05). No statistically significant differences of H2O2 or IL- 6 level in EBC was found between the two groups after 1 day,3 days of mechanical ventilation,respectively( P > 0. 05); while H2O2 and IL- 6 levels in EBC of death group were higher than those of survival group after 5 days,7 days of mechanical ventilation,respectively( P < 0. 05). In survival group,no linear correlation was found between H2O2 or IL- 6 level in EBC at each time point and APACHEⅡ score or APACHEⅢ score( P > 0. 05); in death group,H2O2 in EBC after 5 days,7 days of mechanical ventilation was positively correlated with APACHEⅡ score and APACHEⅢ score,IL- 6 level in EBC after 5 days,7 days of mechanical ventilation was negatively correlated with APACHEⅡ score and APACHEⅢ score( P < 0. 05). Conclusion H2O2 and IL- 6 levels in EBC of patients with ARDS treated with mechanical ventilation are higher and correlate with severity of illness,may be monitoring index of airway inflammatory reaction and provide evidences for predicting the prognosis by combining with APACHE score.更多还原