内皮素1在急性呼吸窘迫综合征炎症反应中的作用

目前认为,炎症反应是急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发病的重要机制.许多研究证明,内皮素1在ARDS炎症反应中发挥促炎作用.本综述通过回顾内皮素系统的研究进展,阐述内皮素1的炎症作用在ARDS的病理生理学机制、通透性肺水肿及肺动脉高压形成中的作用,及内皮素受体拮抗剂的应用现状.     

血管外肺水指数与氧合指数评估急性肺损伤程度准确性的比较

目的 比较血管外肺水指数(EVLWI)与氧合指数(PaO2/FiO2)评估急性肺损伤(ALI)程度的准确性.方法 创伤后(创伤时间＜48 h)ALI行机械通气患者16例,性别不限,年龄18～80岁,采用PiCCO监测仪监测EVLWI,建立PiCCO监测后每隔24 h采集动脉血样,测定PaO2,计算PaO2/FiO2;同时记录EVLWI,并进行肺损伤评分(LIS).分别在建立HCCO监测后24、48、72 h时按PaO2/FiO2将患者分为PaO2/FiO2≤300组(200 mm Hg＜PaO2/FiO2≤300 mm Hg)和PaO2/FiO2≤200组(PaO2/FiO2≤200 mm Hg),按EVLWI将患者分为EVLWI＜10组(EVLWI＜10 ml/kg)和EVLWI≥10组(EVLWI≥10 ml/kg).结果 与PaO2/FiO2≤300组比较,PaO2/FiO2≤200组建立PiCCO监测后24、48 h时LIS评分差异无统计学意义(P＞0.05),建立PiCCO监测后72 h时LIS评分升高(P＜0.01).与EVLWI＜10组比较,EVLWI≥10组各时点LIS评分均升高(P＜0.05或0.01).结论 临床中PaO2/FiO2作为评估ALI程度的指标存在局限性,而EVLWI在评估ALI程度方面可能比PaO2/FiO2更准确.

Abstract：

Objective To compare extravascular lung water index (EVLWI) and oxygenation index (PaO2/FiO2) in estimation of acute lung injury(ALI) .Methods Sixteen patients with post traumatic ALI (within 48 h) of both sexes, aged 18-80 yr, were studied. The patients were mechanically ventilated. Right internal jugular vein and femoral artery were catheterized and connected to PiCCO monitor (IntelliVue MP50, Philips, Netherlands).EVLWI was monitored with the PiCCO system. PaO2 was determined every 24 h. ALI was diagnosed based on the following criteria:(1)PaO2/FiO2≤300 mm Hg; (2)X-ray chest film-patchy shadows in the bilateral lungs and (3) CVP≤12 mm Hg.Lung injury score(LIS) was recorded. The patients were divided into PaO2/FiO2≤ 300 group and ≤200 group and EVLWI ≥ 10 group and ＜ 10 group. Results There was no significant difference in LIS between PaO2/FiO2 ≤300 group and PaO2/FiO2 ≤200 group at 24 and 48 h of PiCCO monitoring. At 72 h of PiCCO monitoring LIS was significantly increased in PaO2/FiO2 ≤200 group as compared with PaO2/FiO2 ≤300 group, LIS was significantly higher in EVLWI≥ 10 group than in EVLWI ＜ 10 group at 24, 48 and 72 h of PiCCO monitoring. Conclusion EVLWI is more accurate than PaO2 /FiO2 in estimation of severity of ALI.     

急性呼吸窘迫综合征患者血浆内皮素-1浓度变化的分析

目的分析急性呼吸窘迫综合征(ARDS)患者血浆内皮素-1(ET-1)浓度的变化。方法创伤并发ARDS患者14例, 男性8例, 女性6例, 年龄19～80岁, 发病入ICU后, 以ARDS柏林定义的标准, 对患者ARDS严重程度进行分级。入ICU第1、3、5天取静脉血样, 采用放射免疫法测血浆ET-1浓度;采用PiCCO技术测定肺血管通透性指数(PVPI);并进行多脏器功能障碍(MOD)评分及肺损伤评分(LIS), 对血浆ET-1浓度与MOD评分、LIS及PVPI进行Spearman相关分析。结果轻度ARDS患者(n=5)MOD评分、LIS、PVPI及血浆ET-1浓度低于中度ARDS患者(n=9, P<0.05)。血浆ET-1浓度与MOD评分、LIS、PVPI均呈正相关(r=0.69、0.76、0.62, P<0.001)。结论在ARDS发病早期血浆ET-1浓度可反映患者肺血管通透性乃至病情严重程度, 有必要进行动态监测。