摘要
目的探讨行有创机械通气治疗急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者血清Clara细胞蛋白16(Clara cell protein 16,Cc16)表达及与肺顺应性的关系。方法行有创机械通气治疗ARDS患者69例(观察组),同期行有创机械通气治疗非ARDS患者51例(对照组),采用ELISA法检测2组有创机械通气治疗3h内血清Cc16水平,并记录肺顺应性、呼吸频率、气道平均压、气道峰压、潮气量及呼气末正压(positive end expiratory pressure,PEEP),Pearson相关法分析血清Cc16水平与肺顺应性等指标的相关性。结果观察组有创机械通气治疗3h内血清Cc16[(59.25±17.62)ng/L]、气道峰压[(21.50±5.73)mm Hg]、气道平均压[(11.64±3.43)mm Hg]、PEEP[(4.42±1.67)cm H_2O]]、呼吸频率[(22.05±6.37)次/min]均高于对照组[(31.47±20.49)ng/L、(17.29±4.26)mm Hg、(8.67±1.74)mm Hg、(3.67±0.80)cm H_2O]、(18.54±5.63)次/min](P<0.05),肺顺应性[(37.74±13.59)mL/cm H_2O]]低于对照组[(50.64±24.99)mL/cm H_2O]](P<0.05),潮气量[(466.44±110.93)mL]与对照组[(445.17±105.50)mL]比较差异无统计学意义(P>0.05);Pearson相关分析结果显示,观察组有创机械通气治疗3h内血清Cc16水平与肺顺应性呈负相关(r=-0.252,P=0.036),与呼吸频率、潮气量、气道峰压、气道平均压及PEEP无线性相关(r=-0.015,P=0.835;r=-0.171,P=0.902;r=-0.007,P=0.816;r=-0.026,P=0.865;r=0.068,P=0.783);对照组有创机械通气治疗3h内血清Cc16水平与PEEP呈正相关(r=0.281,P=0.046),与肺顺应性、潮气量、呼吸频率、气道峰压及气道平均压无线性相关(r=-0.018,P=0.612;r=-0.148,P=0.536;r=-0.109,P=0.928;r=0.019,P=0.653;r=0.077,P=0.537)。结论 ARDS患者肺顺应性降低,且与血清Cc16水平呈负相关。
Objective To investigate the expression of Clara cell protein 16 （Cc16） and its relationship with lung compliance in patients with acute respiratory distress syndrome （ARDS） undergoing mechanical ventilation. Methods Sixty-nine patients with ARDS （observation group） and 51 patients with non-ARDS （control group） undergoing invasive mechanical ventilation were detected the serum Cc16 level by ELISA after 3-h ventilation, and were recorded the lung compliance, respiratory rate, mean pressure, peak pressure, tidal volume and positive end expiratory pressure （PEEP）. Pearson correlation method was used to analyze the relationship of serum Cc16 level with lung compliance and other indicators. Results The serum Cc16 level （（59.25±17.62） ng/L）, peak airway pressure （（21.50± 5.73） mm Hg）, mean airway pressure （（11.64±3.43） mm Hg）, PEEP （（4.42±1.67） cm H2O） and respiratory rate （（22.05＋6.37） time/rain） in observation group were significantly higher than those in control group （（31.47±20.49） ng/L, （17.29± 4.26） mm Hg, （8. 67±1. 74） mm Hg, （3. 67±0. 80） cm H2O, （18. 54±5. 63） time/rain） （P〈0.05）, the lung compliance （（37. 74± 13. 59） mL/cm H2O） was significantly lower than that in control group （（50. 64±24. 99） mL/em H2O）） after 3-h ventilation （P〈 0.05）, and there was no significant difference in the tidal volume between observation group （（466.44±110.93） mL） and control group （（445.17±106.50） mL） （P〈0.06）. Pearson correlation analysis showed that serum Cc16 level was negatively correlated with the lung compliance （r=-0. 252, P=0. 036）, and not correlated with the respiratory rate, tidal volume, peak airway pressure, mean airway pressure and PEEP （r=-0.015, P=0.835; r=-0. 171, P=0.902; r=-0. 007, P=0.816; r=-0.026, P=0.865; r=0.068, P= 0. 783） in observation group, while was positively correlated with PEEP （r= 0. 281, P= 0. 046）, and not linearly correlated with lung compliance, tidal volume, respiratory rate, peak airway pressure and mean airway pressure （r= 0.018, P=0.612; r= 0. 148, P=0.536; r=-0. 109, P=0.928; r=0.019, P=0.653; r=0.077, P= 0. 537）. Conclusion The lung compliance in patients with ARDS decreases, and is negatively correlated with serum Ccl 6 level.
作者
林锦乐
傅萱
曾世永
叶剑滨
张文武
沈志明
田方
LIN Jin-le , FU Xuan, ZENG Shi yong, YE Jian-bin, ZHANG Wen-wu, SHEN Zhi-ming, TIAN Fang(Department of Critical Care Medicine, Bao＇an District People＇s Hospital of Shenzhen, Shenzhen 518101, Chin)
出处
《中华实用诊断与治疗杂志》
2018年第3期265-268,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
广东省深圳市卫生计生系统科研项目(201506078)
广东省深圳市卫生计生系统科研项目(201604130564)
广东省深圳市科技创新委员会科研项目(JCYJ20150402152005633)
广东省深圳市科技创新委员会科研项目(JCYJ20170307094345589)
深圳市宝安区科技计划项目(201403)
深圳市宝安区科技计划项目(201586)
深圳市宝安区科技计划项目(2016159)
深圳市宝安区科技计划项目(2016157)
