小潮气量加呼气末正压通气治疗ALI/ARDS对肺表面活性物质蛋白A的影响及意义

Influence and Significance of Small Tidal Volume and PEEP on SP-A in ALI/ARDS

目的:通过研究小潮气量联合呼气末正压机械通气对于急性肺损伤所继发的急性呼吸窘迫综合征患者的肺表面活性物质蛋白A(SP-A)水平的影响以及临床疗效。方法:将2010年7月至2015年7月期间于我院治疗的急性肺损伤后并发ARDS的64例患者作为本研究的对象,随机分为实验组与对照组各32例,对照组患者给予传统的机械通气,而实验组患者采取小潮气量联合呼气末正压通气方式,容许性的高碳酸血症通气;测定所有患者气道灌洗液中的SP-A水平以及总磷脂、饱和磷脂以及总蛋白的水平,同时对比两组患者的通气参数以及并发症发生情况。结果:实验组患者通气治疗后SP-A水平显著高于对照组,并发症以及病死率显著低于对照组患者(P<0.05)。结论:小潮气量联合呼气末正压机械通气可以明显改善由急性肺损伤继发的急性呼吸窘迫综合征患者的表面活性物质蛋白A的合成以及表达,增强其在肺部的活性,有助于促进ARDS患者的肺泡复张,改善缺血缺氧表现。

Objective ： To investigate the influence and effect of small tidal volume and PEEP to airway lavage surfactant protein A（SP-A） in ALI / ARDS. Methods ： 64 cases of patients with ARDS caused by acute lung injury from July 2010 to July 2015 as the object of the study were randomly divided into experimental group（32 cases） and control group（32 cases）. Patients in the control group were treated with conventional mechanical ventilation, while patients in the experimental group were taken to a small tidal volume and PEEP way, admissibility hypercapnia ventilation. SP-A levels, total phospholipids, saturated phospholipid and total protein levels were compared between two groups. Ventilatory parameters and complications were compared between two groups. Results ： SP-A levels in the experimental group was significantly higher than that of the control group. The rate of complications and mortality in the experimental group were significantly lower than those of the control group. Conclusion ： Small tidal volume and PEEP mechanical ventilation can significantly improve the synthesis and expression of SP-A of ARDS patients caused by ALI, enhance its activity in the lungs, contribute to ARDS alveolar recruitment of patients, improve the performance of ischemia and hypoxia.