气道压力释放通气对急性呼吸窘迫综合征患者呼吸机相关性肺损伤的影响

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...

Effect of airway pressure release ventilation on ventilator-induced lung injury in patients with acute respiratory distress syndrome

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.