摘要
目的 探讨机械通气对全身炎症反应综合征（SIRS）患者血管内皮功能的影响。方法所有入选的SIRS患者按是否进行机械通气治疗分为机械通气组（35例）和非机械通气组（43例）。分别于人院1d和7d抽取静脉血，测定一氧化氮（NO）、血管紧张素转换酶（ACE）、内皮素-1（ET-1）水平及外周血内皮细胞（CEC）数量。结果人院后机械通气组不同时间点急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分均显著高于非机械通气组（P均〈0．01）。两组各项检测指标在不同时间点与APACHEⅡ评分均显著相关且回归系数近似。协方差分析显示，除NO与APACHEⅡ评分呈显著负相关，其余指标均为显著正相关。入院1d两组各检测指标差异均无显著性（P均〉0.05）；而入院7d机械通气组与非机械通气组比较，除NO显著降低外，ET一1、ACE及CEC均显著升高（P均〈0．05）。NO及APACHEⅡ评分对预后的预测有显著意义，可建立Logistic回归方程。结论SIRS患者血管内皮功能的损害程度与疾病严重程度呈高度相关性，说明机械通气对血管内皮功能的损伤非常明显。
Objective To study the effect of mechanical ventilation on vascular endothelial function in patients with systemic inflammatory response syndrome （SIRS）. Methods All patients showing SIRS were divided into two groups., mechanical ventilation （MV） group （n= 35） and non- MV group （n = 43）. Nitric oxide （NO）, angiotensin- convertion enzyme （ACE）, endothelin- 1 （ET- 1）, and circulating endothelial cells （CEC） of each patient were measured on the 1 st and 7 th day after admission. Results Acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores of MV group were significantly higher than those of non -MV group at different time points after admission （all P〈0.01）. There was significant correlation of APACHE Ⅱ with each inflammatory mediator at each time point and the coefficients were similar. By analysis of covariance, NO and APACHE Ⅱ score were negatively correlated, other indexes were positively correlated with APACHE Ⅱ score. There were not significant variances in two groups on the 1 st hospital day （all P〈0.05）; but on the 7 th hospital day, the levels of ET - 1, ACE and CEC were all increased, but NO decreased （all P〈0.05）. NO content and APACHE Ⅱ score could forecast the prognosis with the conclusion of Logistic analysis. Conclusion There are very high correlations between the degree of vascular endothelial dysfunction and the seriousness of diseases in patients with SIRS. MV exerts significant damage to the vascular endothelial function in patients.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第3期168-171,共4页
Chinese Critical Care Medicine
关键词
全身炎症反应综合征
机械通气
血管内皮
systemic inflammatory response syndrome
mechanical ventilation
vascularendothelium
