儿童急性呼吸窘迫综合征肺泡灌洗液中巨噬细胞的动态变化

目的 观察儿童急性呼吸窘迫综合征(ARDS)肺泡灌洗液(BMLF)中肺泡巨噬细胞(AM)的变化规律，评价巨噬细胞在ARDS早期诊断的作用。方法16例患儿在确诊为ARDS后6h检测血清巨噬细胞移动抑制因子(MIF)浓度，并于6h、12h、18h分别收集肺泡灌洗液检查白细胞总数及分类，8例正常儿童及16例肺炎急性期患儿检测血清MIF。并收集一次肺泡灌洗液并作细胞计数和分类。结果ARDS患儿．MIF显著高于正常儿童及肺炎患儿。BALF肺泡巨噬细胞数在ARDS患儿显著高于肺炎儿童组及正常对照组。随着病程推移，ARDS患儿BALF肺泡巨噬细胞肝占比例呈逐渐下降趋势。而白细胞总数及中性粒细胞数(GRAN)所占比例逐渐增高。结论肺泡巨噬细胞可能是ARDS的早期效应细胞，在启动和激活多形核细胞的趋化和炎症的发展中起重要作用。     

丹参对ARDS大鼠肺损伤的治疗保护和对肺泡巨噬细胞分泌细胞因子的调节作用

目的了解丹参对大鼠血气改变和肺系数的影响以及丹参对肺泡巨噬细胞分泌肿瘤坏死因子(TNF a)、白介素-1(IL-1)的调节作用.方法静注油酸制造ARDS大鼠模型为油酸组,静注生理盐水作对照组,静注油酸同时以丹参灌胃为治疗组.静注油酸及生理盐水6小时后,测定左心PaO2、PaCO2及肺系数.分离培养各组大鼠肺泡巨噬细胞,采用MTT法测定TNF a、IL-1.结果油酸组PaO2值明显低于对照组和治疗组,而PaCO2值明显高于对照组和治疗组(P＜0.001).治疗组血气明显好于油酸组(P＜0.05).油酸组肺系数(1.03±0.06)高于治疗组(0.72±0.05)和对照组(0.64±0.06),P＜0.01.TNF a、IL-1分别为油酸组(72.06±5.64)%、(96.22±11.61)U/ml,对照组(7.75±1.05)%、(21.05±3.11)U/ml,治疗组(35.44±4.55)%、(70.66±8.23)U/ml.油酸组分泌TNFa、IL-1的水平显著高于对照组(P＜0.001),治疗组亦显著高于对照组,但明显低于油酸组(P＜0.001).结论丹参对ARDS有保护性治疗作用,对ARDS大鼠肺泡巨噬细胞过度活化、分泌TNF a、IL-1具有抑制作用.研究对肺泡巨噬细胞分泌细胞因子的调节作用对认识ARDS的发病机制和指导临床治疗有重要意义.     

Phospholipasic and prophospholipasic activities in bronchoalveolar lavage fluid in severe acute pulmonary disease with or without ARDS

Bronchoalveolar lavages were performed in 21 patients undergoing mechanical ventilation: Group I: coma due to sedative overdose (11 cases), without pulmonary impairment, serving as control group; Group II: severe acute pulmonary disease without ARDS (5 cases); Group III: patients with ARDS (5 cases). In the recovered fluid we measured: total proteins (P) and phospholipids (PL), phospholipasic (PLase) and prophospholipasic (PPLase) activities. In ARDS group, considerable increase of P, (p<0.001), and a doubling of PL (p<0.02) was found. Total PLase activity was present in all three groups, with a higher mean level in Group III (p<0.01). PPLase activities were low or untetectable in four patients of this group. PLase/PL ratio was increased in acute respiratory insufficiency, with or without ARDS, suggesting an increase of surfactant catabolism. The decrease of this ratio when pulmonary function improved, or its increase after deterioration suggest that it is related to changes of surfactant.     

Association of PEEP with two different inflation volumes in ARDS patients: effects on passive lung deflation and alveolar recruitment

Objective: To assess the effects of the association of positive end-expiratory pressure (PEEP) with different inflation volumes (V_T's) on passive lung deflation and alveolar recruitment in ARDS patients.¶Design: Clinical study using PEEP with two different V_T's and analyzing whether passive lung deflation and alveolar recruitment (Vrec) depend on end-inspired (EILV) or end-expired (EELV) lung volume in mechanically ventilated ARDS patients.¶Setting: Medical intensive care unit in a university hospital.¶Patients and participants: Six mechanically ventilated consecutive supine patients with ARDS.¶Interventions: Time-course of thoracic volume decay during passive expiration and Vrec were investigated in six ARDS patients ventilated on PEEP with baseline V_T (V_T,b) and 0.5V_T (0.5V_T,b), and on zero PEEP (ZEEP) with V_T,b. Time constants of the fast (τ ₁) and slow (τ ₂) emptying compartments, as well as resistances and elastances were also determined.¶Measurements and results: (a) the bi-exponential model best fitted the volume decay in all instances. The fast compartment was responsible for 84 ± 7 (0.5V_T,b) and 86 ± 5 % (V_T,b) on PEEP vs 81 ± 6 % (V_T,b) on ZEEP (P:ns) of the exhaled V_T, with τ ₁ of 0.50 ± 0.13 and 0.58 ± 0.17 s vs 0.35 ± 0.11 s, respectively; (b) only τ ₁ for V_T,b on PEEP differed significantly (P < 0.02) from the one on ZEEP, suggesting a slower initial emptying; (c) for the same PEEP, Vrec was higher with a higher volume (V_T,b) than at a lesser one (0.5V_T,b), reflecting the higher V_T.¶Conclusions: In mechanically ventilated ARDS patients: (a) the behavior of airway resistance seems to depend on the degree of the prevailing lung distension; (b) alveolar recruitment appears to be more important when higher tidal volumes are used during mechanical ventilation on PEEP; (c) PEEP changes the mechanical properties of the respiratory system fast-emptying compartment.     

Cytokeratin 19 fragments in patients with acute lung injury: a preliminary observation

Objective Cytokeratin 19 (CK19) is a specific cytoskeletal structure for alveolar epithelium. We hypothesized that the levels of CK19 fragments in bronchoalveolar lavage (BAL) fluid could serve as an index of epithelial injury and as a prognosis marker in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The aims of our study were, in patients with ALI/ARDS: (1) to measure CK19 fragments concentrations in BAL fluid, (2) to assess its prognostic value, and (3) to identify the cellular source of CK19 in the alveolar space.Design Prospective preliminary study.Setting University hospital surgical ICU.Patients Twenty-two mechanically ventilated patients with ALI/ARDS and 10 non-ventilated control patients. Plasma samples were obtained for 11 ALI/ARDS patients.Measurements and results The concentration of BAL CK19 fragments was higher in patients (median 4916 pg/ml, 25th–75th percentile 2717–10533) than in controls (2208 pg/ml. 767–3923; p = 0.05), and higher in 10 non-survivors (7051 pg/ml, 4372–13371) than in 12 survivors (2888 pg/ml, 1315–5639; p = 0.03 among ALI/ARDS patients). BAL CK19 fragment concentration did not correlate with simplified acute physiologic score, lung injury score or PaO₂/FIO₂ ratio, but correlated positively with BAL albumin concentration (p = 0.002) and with number of BAL macrophages (p = 0.0001). Plasma CK19 fragment concentrations were 10 times lower than those in BAL. Immunohistochemical staining for CK19 showed a strong labelling of injured detached epithelial cells and hyperplastic epithelium in ALI/ARDS lung samples.Conclusion CK19 fragment concentrations were found to be elevated in BAL fluid in ALI/ARDS patients compared with control subjects. High BAL CK19 fragment levels were associated with a poor prognosis.Electronic supplementary material The electronic reference of this article is . The online full-text version of this article includes electronic supplementary material. This material is available to authorised users and can be accessed by means of the ESM button beneath the abstract or in the structured full-text article. To cite or link to this article you can use the above reference.     

肺泡蛋白沉着症肺泡灌洗术前后定量CT应用评价

目的 探讨定量CT在肺泡蛋白沉着症(PAP)支气管肺泡灌洗术中的应用价值.方法 定量CT通过分析PAP患者最大吸气末肺容积、肺重量、肺含气体积、平均肺密度及平均含气体积结果,对10例PAP患者共14次(两肺13次,单肺1次)肺泡灌洗术CT资料进行分析.并结合常规CT(病灶范围、密度)、肺功能(检查9次)及血气分析检查(检查14次)结果进行对比分析.结果 PAP经支气管肺泡灌洗术后,定量CT检查显示肺重量从(1594±436) g减低至(1294±374) g(P=0.000),平均肺密度从(0.5269±0.12) g/ml减低至(0.4389±0.09) g/ml(P=0.006),平均肺充气体积从(1.0989±0.5031) ml/g增加至(1.4700±0.4548) ml/g(P=0.008),肺含气体积有一定程度增加(P=0.116),肺容积在灌洗后略增加(P=0.938);肺泡灌洗前后的肺容积与肺含气体积呈显著相关(绝对系数R2=0.94,P=0.000).常规CT评价79%(11/14)CT检查结果改善.支气管肺泡灌洗术后有10次肺功能检查结果示DLCO%从45.85%±22.09%上升到54.64%±19.09%(P＝0.007)、DLCO/VA%从67.30%±22.62%上升到76.03%±18.60%(P＝0.03);FVC%、FEV1%、FEV1/FVC、PEF%也有不同程度改善,但无统计学差异(P＞0.05).14次血气分析显示从肺泡灌洗前的低氧血症[PaO2(8.07±2.1) kpa]到肺泡灌洗后的明显好转[PaO2(14.7±5.24) kpa](P=0.001).结论 定量CT可为PAP疗效评估提供客观依据,肺泡灌洗术后以定量CT结果中的肺重量、平均肺密度及平均含气肺体积改善明显.常规CT评价对PAP疗效观察具有一定价值.通过肺泡灌洗术,大部分患者病情短期内得到显著改善.     

Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS

Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI₂, 12.5–35.0 ng·kg^–1·min^–1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI₂ infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI₂ reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p<0.01). The cardiac index (CI) increased from 4.2 to 5.81·min^–1·m^–2 (p<0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg·min·m²·1^–1,p<0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%,p<0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r=0.789, % RVEF=–2.11·PVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p<0.05) the arterial PO₂ remained constant resulting in an increased oxygen delivery from 657 to 894 ml·min^–1·m^–2 (p<0.01). We conclude that short term infusions of PGI₂ increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI₂ may be useful to lower pulmonary artery pressure in ARDS.Supported by the Deutsche Forschungsgemeinschaft (grant Fa 139/2-2)     

血清及支气管肺泡灌洗液肿瘤标志物测定对肺癌的诊断意义

目的探讨支气管肺泡灌洗液（BALF）和血清中肿瘤标志物细胞角蛋白19片段（CYFRA21—1）,神经元特异性烯醇化酶（NSE）、癌胚抗原（CEA）含量在肺癌诊断过程中的变化、敏感程度及联合检测的意义。方法选择确诊的肺癌患者45例作为检测组,肺部良性病变患者45例作为对照组。使用酶联免疫吸附（ELISA）方法检测两组患者的BALF和血清中CYFRA21—1、NSE、CEA的含量。结果肺癌患者BALF及血清中CYFRA21—1、NSE、CEA浓度明显高于肺良性病变组（P〈0．05）,BALF中CYFRA21—1、NSE、CEA均高于血清中含量。结论肺癌患者BALF和血清中CYFRA21—1、NSE、CEA联合检测对肺癌诊断有较高的临床参考价值。     

10例氯气中毒并发ARDS的救治护理

目的总结10例氯气中毒并发ARDS的救治与护理经验。方法采用合理氧疗、抗感染、应用糖皮质激素等方法,对10例氯气中毒并发ARDS患者进行救治与护理。结果 10例患者均得到及时有效的治疗与护理,全部治愈出院。结论早期、足量、短程应用糖皮质激素,雾化吸入,及时止咳化痰,积极预防感染。在面罩吸氧效果不理想的情况下尽早使用呼吸机正压通气,迅速纠正低氧血症是抢救成功的关键措施。加强呼吸道的管理、加强基础护理是减少并发症的有效措施。     

急性呼吸窘迫综合征患者肺泡微环境对肺成纤维细胞生物学活性的影响

目的探讨不同程度急性呼吸窘迫综合征（ARDS）肺泡微环境的变化对肺成纤维细胞（LF）的影响。 方法以2014年1月至2016年12月绍兴市人民医院重症监护病房（ICU）收治的58例符合ARDS诊断标准的患者,依据患者氧合指数和柏林定义标准将患者分为轻度组（26例）、中度组（15例）、重度组（17例）,另纳入10例行机械通气但无肺部疾病患者作为无肺损伤组。所有入选患者均进行支气管肺泡灌洗,留取支气管肺泡灌洗液（BALF）标本,酶联免疫吸附法（ELISA）检测其中白细胞介素1β（IL-1β）、角质细胞生长因子（KGF）和肝细胞生长因子（HGF）水平,并进行蛋白定量及细胞计数。同时,体外培养肺成纤维细胞系MRC-5细胞,与各组患者BALF共培养,采用Transwell法检测细胞迁移能力,采用Western-blotting法检测各组细胞Collagen Ⅰ和血小板源性生长因子α受体（PDGF-Rα）表达。 结果与无肺损伤组比较,ARDS轻度组、中度组及重度组患者的IL-1β[12（8,21）、776（449,943）、802（691,1 004）、886（548,1 130）ng/L]、KGF[2.0（1.0,2.2）、19.0（15.8,24.5）、41.4（36.2,57.3）、64.7（49.2,82.1）ng/L]、HGF[90（75,106）、514（373,785）、867（674,1 248）、940（660,1 344）ng/L]、蛋白含量[（0.09 ± 0.03）、（0.29 ± 0.10）、（0.45 ± 0.09）、（0.68 ± 0.16）g/L]及细胞总数[（2.4 ± 0.6）、（16.5 ± 2.1）、（17.8 ± 2.0）、（18.2 ± 2.0）× 10⁹个/mL]均明显升高（Z=26.182、55.871、36.354,F=72.860、177.291,P均<0.05）,且与重度组患者比较,轻度组及中度组患者的KGF水平及蛋白含量显著降低（P均<0.05）,轻度组仅HGF水平及总细胞数明显降低（P均<0.05）,而ADRS各组间IL-1β比较,差异均无统计学意义（P均>0.05）。同时,与无肺损伤组比较,ARDS各组间趋化指数均明显升高（F=12.291,P=0.003）,且重度ARDS组患者明显高于轻度及中度组患者（P均<0.05）。四组间CollagenⅠ蛋白及PDGF-Rα蛋白比较,差异均有统计学意义（F=358.943,P=0.001;F=4.574,P=0.002）。ARDS各组CollagenⅠ蛋白明显高于无肺损伤组,且中度、重度组明显高于轻度组（P均<0.05）。而PDGF-Rα蛋白在无肺损伤组和轻度组几乎无表达,但在中度、重度组均有明显表达（P均<0.05）。 结论随着ARDS程度的加重,BALF中KGF、HGF明显上升,BALF可通过诱导LF表达PDGF-Rα和CollagenⅠ,促进LF的迁移与分化。     

Morphological changes in chest radiographs of patients with acute respiratory distress syndrome (ARDS)

Objective: To determine whether the quality of infiltrations in chest radiographs can accurately predict the histological extent of fibrotic change in patients with acute respiratory distress syndrome (ARDS). Design: Retrospective clinical investigation. Setting: Intensive care unit (ICU) of a university teaching hospital. Patients and methods: Of 47 patients treated with extracorporeal membrane oxygenation (ECMO) for severe ARDS over a 5-year period, 23 patients underwent open lung biopsy at thoracotomy for treatment, mostly of pneumothorax. Chest films obtained by portable chest roentgenography preceding the operation were reviewed retrospectively and compared to the histomorphological results of the lung specimen. Results: Chest radiographs displayed mixed alveolar-reticular opacification in 60.2 %, alveolar patterns in 22.9 % and reticular opacities in 10.5 %. In 0.4 % there were no infiltrates, 6 % could not be evaluated because of insufficient quality. There was no relevant difference between the right and left lungs. Subdividing patients into two groups according to the histological results of either absent or mild (1) or severe (2) lung fibrosis, we found an alveolar haziness in 12.3 % in group 1 compared with 28.2 % in group 2, while reticular characteristics were identified in 13 % and 11 %, respectively. Conclusions: The most common opacity in chest radiographs of patients with severe ARDS treated with ECMO is mixed alveolar-reticular opacification. Severe lung fibrosis is not positively correlated with a reticular radiographic pattern. ECMO does not lead to specific radiological changes in conventional radiograms, contrary to clinical findings that treatment with ECMO might induce pleural or pulmonic haemorrhage, especially in the earlier days when systemic heparinization had to be used instead of the heparin-coated tube-surfacing. Received: 24 November 1997 Accepted: 20 July 1998     

Hemodynamic changes during whole bronchoalveolar lavage in two cases of pulmonary alveolar proteinosis

Fove whole bronchoalveolar lavages were performed in 2 patients with pulmonary alveolar proteinosis with continuous monitoring of mixed venous and arterial oxygen saturation. Hemodynamic parameters and gas-exchange status were measured during the different phases of the lavage. In the phase of filled lung, a significant increase of arterial partial pressure (PaO₂) and arterial saturation of oxygen were observed, secondary to a decrease in the intrapulmonary shunt. The mean pulmonary arterial pressure, pulmonary vascular resistances and cardiac index were higher during the filling of the lung as compared to the controls. During the empty lung phase, although PaO₂ decreased (without reaching statistical significance), due to an increase in the intrapulmonary shunt, the increase in cardiac output during this phase left the oxygen delivery (DO₂) unchanged.To be presented in part at the 1991 American Thoracic Society Congress     

1例肺泡蛋白沉积症患儿行全肺灌洗治疗的护理

总结1例因IARS基因突变导致肺泡蛋白沉积症患儿行全肺灌洗治疗围手术期的护理经验.护理要点包括:术前评估患儿对于灌洗治疗的耐受情况,完善术前准备,实施医疗游戏辅导,减少患儿哭吵及氧消耗;术中医护配合完成灌洗治疗,监测患儿血氧饱和度变化;术后进行气道管理、控制感染及监测相关并发症.经过2次入院行全肺灌洗治疗,患儿呼吸困难...     

支气管扩张伴感染患者接受支气管肺泡灌洗的临床疗效

目的:探究支气管扩张伴感染患者应用支气管肺泡灌洗进行治疗的临床效果.方法:随机抽取30例支气管扩张伴感染患者纳入本次研究范围,其均于2016年12月至2019年12月入本院接受诊治,应用等量数字随机方式分组,分别应用支气管肺泡灌洗(研究组,n=15)及常规治疗方式(对照组,n=15)进行临床治疗,分析临床干预效果.结果...     

急性肺损伤患者血清及肺泡灌洗液和肽素水平变化的临床分析

目的观察血清及支气管肺泡灌洗液（BALF）和肽素的变化与急性肺损伤（ALI）患者病情及预后的关系。方法采用ELISA法,测定57例ALI患者血清及BALF的和肽素水平,选择健康体检者32名作为血清对照组（A组）,14名BALF检查无异常的就诊者作为BALF对照组（B组）;ALI患者分为直接和间接肺损伤亚组、轻中度和重度肺损伤亚组、多器官功能障碍综合征（MODS）亚组和非MODS亚组、28d存活亚组和死亡亚组,同时将其和肽素表达水平与急性病生理学和长期健康评价（APACHE）Ⅱ评分、肺损伤评分（LIS）、氧合指数（PaO2／FiO2）进行相关性分析;监测ALI患者确诊第1、3、5、7天血清和肽素水平及第1、7天的BALF和肽素水平。结果ALI患者血清及BALF的和肽素水平明显高于A、B组（P均〈0．01）,直接肺损伤亚组血清和肽素水平与间接肺损伤组无统计学差异（P〉0．05）,直接肺损伤亚组的BALF和肽素水平明显高于间接肺损伤亚组（P〈0．01）;重度肺损伤亚组和MODS亚组的血清和BALF的和肽素水平明显高于轻中度肺损伤亚组和非MODS亚组（P〈0．01）,死亡亚组血清第1、3、5、7天和肽素水平及第1、7天的BALF和肽素水平明显高于存活亚组（P〈0．01）;血清和肽素变化与BALF和肽素水平、LIS评分、PaO2/FiO2呈正相关（r=0．712,P〈0．01;r=0．305,P〈0．05;r=0．435,P〈0．01）,与起始APACHEⅡ评分无相关性（r=0．007,P〉0．05）。结论血清及BALF和肽素水平与肺损伤严重程度具有相关性,可有效评价ALI患者病情及预后。     

Clinical utility and prognostic value of bronchoalveolar lavage galactomannan in patients with hematologic malignancies

We conducted a single-center retrospective cohort study to determine the performance characteristics of the galactomannan (GM) assay in bronchoalveolar lavage (BAL) in patients with hematologic malignancies. Patients were classified as proven, probable, possible, or no invasive pulmonary aspergillosis (IPA), according to international guidelines. A total of 173 BAL samples from 145 patients were included. There were 5 proven, 7 probable, and 35 possible cases of IPA. Using a GM index cutoff of ≥0.5, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) of the BAL GM assay were 100%, 78%, 26%, and 100%, respectively. Using a GM index cutoff of ≥2.0, the sensitivity and NPV remained 100%, but specificity and PPV increased to 93% and 50%, respectively. The BAL GM assay is a highly sensitive screening test for IPA in patients with hematologic malignancies. Increasing the cutoff value to 2.0 would improve the performance of this assay.     

Reliability of mini-bronchoalveolar lavage for the measurement of epithelial lining fluid concentrations of tobramycin in critically ill patients

Objective To evaluate the reliability of mini-bronchoalveolar lavage (mini-BAL) for the measurement of tobramycin concentrations in epithelial lining fluid (ELF) in comparison with conventional bronchoscopic bronchoalveolar lavage (BAL). Design Prospective, open-label study. Setting An intensive care unit and research ward in a university hospital. Patients Twelve critically ill adult patients with ventilator-associated pneumonia (VAP). Interventions All subjects received intravenous infusions of tobramycin 7–10 mg/kg once daily. After 2 days of therapy, the steady-state serum and ELF concentrations (obtained from BAL and mini-BAL) of tobramycin were determined by means of high-performance liquid chromatography. Measurements and results We observed poor penetration of tobramycin in ELF of ≈ 12% with ELF peak concentrations of ≈ 3 mg/l with both methods. Good agreement in Bland–Altman analysis (mean ± SD bias = 0.04 ± 0.38 mg/l) was observed between the two methods of sampling. Conclusion Our results suggest that tobramycin 7–10 mg/kg once daily in critically ill patients with VAP might provide insufficient lung concentrations in the case of difficult-to-treat pathogens. Besides, mini-BAL, which is simple, non-invasive and easily repeatable at the bedside, appears to be a reliable method for the measurement of antibiotic concentrations in ELF in comparison with bronchoscopic BAL in critically ill patients with VAP. This article is discussed in the editorial available at: . Support was provided only by institutional sources.     

血液滤过对严重创伤后并发急性呼吸窘迫综合征患者氧合功能和血流动力学的影响

目的 研究血液滤过对严重创伤后并发ARDS患者氧合功能和血流动力学的影响。方法 选择严重创伤后ARDS患者12例，在呼吸机辅助或控制呼吸下行血液滤过治疗，于血液滤过后1－5d内用Swan-Ganz漂浮导管监测血流动力学和肺氧功能的变化。结果 与血液滤过前比较，滤过后第1天CVP、MPAP、SVRI、PVRI显著降低，整个血液滤过时间PaO2／FiO2升高非常显著，MAP、PCWP、HR、CI、DO2、VO2、ExtrO2、Qs/Qt无显著变化。结论 血液滤过对严重创伤后ARDS患者的血流动力学和氧合功能无明显影响，但可使氧合指数升高。     

Differential evaluation of bronchoalveolar lavage cells and leukotrienes in unilateral acture lung injury and ARDS patients

Patients with unilateral acute lung injury (UALI; n=6) and ARDS (n=4) were evaluated by bronchoalveolar lavage, as controls we used 5 patients suffering from cerebral hemorrhage and without pulmonary, cardiac or infectious disease who were mechanically ventilated. For each group of patients two independent bronchoalveolar lavages (BAL) were performed. The BAL fluid recovered from the two lungs was immediately analyzed for leukotrienes (LTS) by means of RP-HPLC and stained for cell counts. The BAL from the control group did not show any LTS and the percentage of neutrophils was within the normal range: 1±0.2% right lung and 1.2±0.4% left lung. The BAL fluid from UALI patients showed two different patterns, the injured lung showed high levels of LTS (39.1±8 ng ml^-1 LTB₄; 25±6 ng ml^-1 LTD₄ and 27.8±8.2 ng ml^-111-trans LTC₄) and an increased percentage of neutrophils (74.2±7%) compared to controls. Only 2 out of the 6 patients from the UALI group showed small amounts of LTB₄ (4 ng ml^-1) and LTD₄ (3.2 ng ml^-1). The BAL obtained from the healthy lung in both cases showed values of LTS almost eight fold lower than those present in the injured lung. The percentage of neutrophils from the unaffected lungs (4.3±7%) was not significantly different from controls. Lavage fluid from ARDS patients showed a similar picture to that of the affected lung from UALI patients. Evaluation of ARDS lavage fluid demonstrated the presence of the same LTS (LTB₄, LTD₄ and 11-trans LTC₄) with concentrations similar to those found in the injured lung of UALI subjects. The amount of LTB₄ (a very potent chemotatic factor) correlated directly with the percentage of neutrophils both in ARDS and the diseased lung of UALI patients. These findings suggest that LTS and neutrophils participate in the pathophysiology of UALI and ARDS, and that UALI is a localized pathologic entity similar to ARDS.The data from this study have been partially presented, as communication, during the 4th European Congress on Intensive Care Medicine in Baveno, June 14–18, 1988.This work is partially supported by MPI 601 CAP 02112.01.04 1984/1989.