机械通气患者气道胃蛋白酶与VAC关系的研究

Study on the relationship between airway pepsin and VAC in patients with mechanical ventilation

目的:调查机械通气患者不同角度下呼吸机相关性疾病(VAC)的发生情况及气道分泌物胃蛋白酶含量的临床意义。方法:将2017-01-2017-02期间入住ICU机械通气(MV)>2d的机械通气患者90例随机分为3组,组1为床头抬高角度15°,组2床头抬高角度为30°,组3床头抬高角度为45°,分别在每天上午9点和21点收集支气管分泌物,用放射免疫分析技术测定其胃蛋白酶含量,收集机械通气患者48h后呼吸机参数24h最低PEEP及FIO2指标,进行VAC目标性监测,统计VAC发生率,并根据是否发生VAC分组,对预后指标进行统计分析呼吸机相关疾病对机械通气患者脱机拔管时间的影响。结果:组1患者中胃蛋白酶测定值为(58.97±9.57)U/ml;组2患者中胃蛋白酶测定值为(57.31±8.58)U/ml;组3患者中胃蛋白酶测定值为(46.347 8±9.36)U/ml,3组患者胃蛋白酶含量均有统计学意义(P<0.05),其中组3较组1和组2更差异有统计学意义,随着胃蛋白酶含量增高,患者机械通气PEEP及FIO2条件增加,胃蛋白酶测定值为(69.85±4.79)U/ml发生VAE,胃蛋白酶测定值为(52.20±9.28)U/ml未发生VAC。结论:机械通气患者更易发生VAC,支气管分泌物胃蛋白酶测定可用于危重机械通气患者预测VAC的发生,VAC的判断指标基于MV参数,更客观、准确。

Objective：To investigate the incidence of ventilator-Associated Condition（VAC）and the clinical significance of airway secretions（PEP）in patients with mechanical ventilation.Method：Ninety patients with mechanical ventilation（IC）aged ≥18 years and mechanical ventilation（MV）2 days were randomly divided into 3 groups.Group 1 was bedside elevation angle of 15°,group 2 Bedside elevation angle of 30°,group 3 bed elevation angle of 45°,respectively,at the same time to collect bronchial secretions,with radioimmunoassay analysis of its pepsin content,collected mechanical ventilation after 48 hventilator parameters 24 h The minimum PEEP and FIO2 were measured and the VAC target was monitored.The incidence of VAC was counted and the influence of ventilator-related diseases on the time of offline extubation in patients with mechanical ventilation was analyzed according to whether VAC was generated or not.Result：The determination of pepsin in group 1 was（58.97±9.57）U/ml;the determination of pepsin in group 2 was（57.31±8.58）U/ml;the determination of pepsin in group 3 was（46.3478±9.36）U/ml（P〈0.05）.With the increase of pepsin content,PEEP and FIO2 were increased in the patients,and the determination of pepsin was（69.85±4.79）U/ml.The results showed that the content of pepsin was higher than that of the control group（P〈0.05）.The value is（52.20±9.28）U/ml does not occur VAC.Conclusion：Patients with mechanical ventilation are more likely to develop VAC,bronchial secretions pepsin assay can be used to predict the occurrence of VAC in critically ill patients,VAC is based on MV parameters,more objective and accurate.