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1、临床肺科杂志2014年7月第19卷第7期1237不同潮气量机械通气对脑卒中患者炎症趋化因子的影响1232张劲松吴海青孔德琼罗旭【摘要】目的观察不同潮气量机械通气时无肺疾病患者血浆及支气管肺泡灌洗液(BALF)白细胞介素-8(IL-8)及亲环素A(CyPA)的变化,方法20例脑出血或脑梗塞的患者随机分成两组:高潮气量组(10ml/kg)和低潮气量组(6ml/kg),两组吸入氧浓度均为40%,呼气末正压5cmHO,呼吸频率设定以维持2PaCO35%~40%。机械通气初及24h后,取静脉血及BALF分别检测血浆及BALF
2、的TNF-α、IL-8、CyPA含2量。结果两组病人机械通气前后血浆IL-8、CyPA无明显变化(P>0．05),24h后BALF的IL-8、CyPA变化:高潮气量组较机械通气初明显升高(P<0．05),低潮气量组机械通气前后无明显变化(P>0．05),低潮气量组较高潮气量组明显降低(P<0．05)。结论传统的高潮气量通气可以引起肺的白细胞趋化因子IL-8、CyPA升高,从而诱发肺的炎症反应,低潮气量通气可以限制肺的炎症反应。【关键词】机械通气;潮气量;支气管肺泡灌洗液;白细胞介素-8;亲环素AInfluenceo
3、fmechanicalventilationwithdifferenttidalvolumeoninflammationchemotaticfactorinpatientswithcerebralstrokeZHANGJing-song,WUHai-qing,DONGDe-qiong,LUOXutheSecondMedicalDepart-ment,People′sHospitalofLonghuaNewDistrict,Shenzhen,Guangdong518109,China【Abstract】Objecti
4、veToobservethevariationofinterleukin-8(IL-8)andcyclophilinA(CyPA)inpa-tientswithoutlungdiseasedurationmechanicalventilation(MV)withdifferenttidalvolumes.Methods20patientswithcerebralstrokewererandomlydividedintotwogroups.ThegroupAreceived10ml/kgofmechanicalven
5、tila-tion,andthegroupBreceived6ml/kgofmechanicalventilation.Allpatientsweregivenanoxygeninspiratoryfrac-tion(FiO)of40%andsetbreathfrequencytokeepPaCO35-40%withpositiveend-expiratorypressure(PEEP)22of5cmHOduring24hoursafteradmission.IL-8andCyPAconcentrationswer
6、emeasuredintheserumandinthe2bronchoalveolarlavagefluid(BALF)atadmissionand24hoursafterthetreatment.ResultsTherewasnosignifi-cantdifferenceinserumIL-8andCyPAbetweenthetwogroupsbeforeandafterthetreatment(P>0．05).Thelev-elsofIL-8andCyPAinBALFwerestableinthelowVTg
7、roup(P>0．05),buttheyincreasedinthehighVTgroup(P<0．05).After24hours,thelevelsofIL-8andCyPAwerehigherinthehighVTgroupthaninthelowVTgroup(P<0．05).ConclusionTheapplicationofhighertidalvolumesmayinducepulmonaryinflammationandtheuseoflowertidalvolumesmaylimitpulmona
8、ryinflammationinmechanicallyventilatedpatientsevenwithoutlunginjury.【Keywords】mechanicalventilation;tidalvolume;bronchoalveolarlavagefluid;interleukin-8;cyclophilinA[2,3]机械通气治疗已经成为
