高频正压通气模式对烟雾吸入性肺损伤致急性呼吸窘迫综合征青年患者白介素水平的影响

Effect of high frequency percussive ventilation on interleukin level in young patients with acute respiratory distress syndrome induced by smoke inhalation injury

目的本研究探讨高频正压通气模式对烟雾吸入性肺损伤后呼吸窘迫青年患者白介素水平的影响。方法选择解放军总医院2010年1月-2016年6月因烟雾吸入性肺损伤所致急性呼吸窘迫综合征的入院青年患者（〈45岁）23例，收集临床资料，包括性别、年龄及APACHEⅡ评分及生化指标。呼吸机使用高频正压通气模式，通气后每6h、24h、48h记录肺功能生理参数包括氧合指数、平台压力、吸气峰值压力、呼气末正压、平均气道压力、潮气量等，在使用高频正压通气模式前和通气后2h、12h、24h、48h采集血液样品进行白介素-6、白介素-8测定，对比分析高频正压通气前后白介素-6、白介素-8水平的差异。结果高频正压通气前所有患者白介素-6和白介素-8水平明显高于正常值（54vs88pg／ml，P〈0．05；8vs289pg／mL，P〈0．05），在气管插管和利用高频正压通气建立正压通气后，2h内没有显著增加，随后白介素-8水平显著降低（289pg/mLvs72pg/mL，P=0．001），插管后氧合指数显著增加（117±53VS243±70，P=0．001）。结论在仅有轻度烧伤的青年呼吸窘迫综合征患者中，高频机械通气模式不会增加IL-6和IL-8的初始水平，高频正压通气模式的使用不会加剧烟雾吸入所致肺损伤。

Objective To investigate the effect of high frequency percussive ventilation on interleukin （IL） levels in young patients with respiratory distress induced by smoke inhalation injury. Methods Twenty-three young patients （〈45 years old） with acute respiratory distress syndrome （ARDS） induced by smoke inhalation injury in Chinese PLA General Hospital from January 2010 to June 2016 were recruited. Clinical data including gender, age and APACHE II score and biochemical parameters were collected. All patients accepted high-frequency positive pressure ventilation therapy. Pulmonary function and physiological parameters including oxygenation index, plateau pressure, inspiratory peak pressure, mean airway pressure, and tidal volume were recorded after ventilation every 6 hours, 24 hours, 48 hours. Blood samples were collected at 2 hours, 12 hours, 24 hours, and 48 hours after ventilation for interleukin-6 and interleukin-8. The levels of interleukin-6 and interleukin-8 before and after high-frequency ventilation were measured and compared. Results The levels of IL-6 and IL-8 were significantly higher in all patients （54 vs 88 pg/ ml, P 〈0.05; 8 vs 289 pg/ml , P 〈0.05） before high-frequency positive airway ventilation. There was no significant increase in IL-8 level after 2-hour ventilation, and a significant increase in PaO2/FiO2 （ 117±53 vs 243±70, P = 0.001） after intubation. Conclusions In young patients with mild respiratory distress syndrome, high-frequency mechanical ventilation may not increase the initial levels of IL-6 and IL-8, and the use of high frequency percussive ventilation may not exacerbate smoke inhalation Induced lung injury.