(美文欣赏)小潮气量+PEEP机械通气可抑制预先无肺损伤患者肺部炎症反应

lencho83

小潮气量+PEEP机械通气可抑制预先无肺损伤患者肺部炎症反应



背景：大潮气量机械通气可加重ALI/ARDS患者肺部损伤。本文拟研究短期机械通气对预先无肺损伤患者局部炎症反应的影响。方法：拟行择期手术（手术时程≥5小时）的患者，随机纳入大潮气量（12ml/kg，理想体重）无PEEP组、小潮气量（6ml/kg,理想体重）+PEEP（10cm H2O）。在麻醉诱导及5小时后，检测支气管肺泡灌洗液和（或）血液中多形核细胞、炎症标志物水平及核小体改变情况。结果：小潮气量+PEEP（n=21）可降低肺内IL-8、MPO、弹性蛋白酶水平，而在大潮气量无PEEP组（n=19），IL-8、MPO、弹性蛋白酶均明显升高，但在机械通气5小时后，仅发现MPO在两种通气方案中有差异（P < 0.01）。机械通气不影响支气管肺泡灌洗液中TNFα、IL-1α、IL-1β、IL-6、巨噬细胞炎症蛋白1α、巨噬细胞炎症蛋白1β水平。机械通气可升高血浆IL-6、IL-8水平，但两组间无明显差异。结论：小潮气量+PEEP机械通气可能抑制预先无肺损伤患者的肺部炎症反应。小潮气量通气及PEEP对肺的保护效应尚需进一步研究。
1 Anesthesiology. 2008 Jan;108(1):46-54.
•  Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury.
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•  Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, van der Poll T, Vroom MB, Hollmann M, Schultz MJ.

•  Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. [email protected]

•  BACKGROUND: Mechanical ventilation with high tidal volumes aggravates lung injury in patients with acute lung injury or acute respiratory distress syndrome. The authors sought to determine the effects of short-term mechanical ventilation on local inflammatory responses in patients without preexisting lung injury. METHODS: Patients scheduled to undergo an elective surgical procedure (lasting > or = 5 h) were randomly assigned to mechanical ventilation with either higher tidal volumes of 12 ml/kg ideal body weight and no positive end-expiratory pressure (PEEP) or lower tidal volumes of 6 ml/kg and 10 cm H2O PEEP. After induction of anesthesia and 5 h thereafter, bronchoalveolar lavage fluid and/or blood was investigated for polymorphonuclear cell influx, changes in levels of inflammatory markers, and nucleosomes. RESULTS: Mechanical ventilation with lower tidal volumes and PEEP (n = 21) attenuated the increase of pulmonary levels of interleukin (IL)-8, myeloperoxidase, and elastase as seen with higher tidal volumes and no PEEP (n = 19). Only for myeloperoxidase, a difference was found between the two ventilation strategies after 5 h of mechanical ventilation (P < 0.01). Levels of tumor necrosis factor alpha, IL-1alpha, IL-1beta, IL-6, macrophage inflammatory protein 1alpha, and macrophage inflammatory protein 1beta in the bronchoalveolar lavage fluid were not affected by mechanical ventilation. Plasma levels of IL-6 and IL-8 increased with mechanical ventilation, but there were no differences between the two ventilation groups. CONCLUSION: The use of lower tidal volumes and PEEP may limit pulmonary inflammation in mechanically ventilated patients without preexisting lung injury. The specific contribution of both lower tidal volumes and PEEP on the protective effects of the lung should be further investigated.

christinepoppy

什么是小潮气量？

drdr2007

嘿嘿 翻译的 比较专业啊！
我要努力学习啊