呼出气NO在急性呼吸窘迫综合征病情评价中的应用

Application of exhaled NO in the condition evaluation of acute respiratory distress syndrome

目的探讨呼出气NO在急性呼吸窘迫综合征病情评价中的应用。方法收集2015年9月~2017年9月在本院ICU确诊为急性呼吸窘迫综合征(ARDS)的患者102例为实验组,同时收集22例门诊体检的正常人作为对照组。所有病例均按照2012年柏林标准筛选入组。实验组经过两周ICU进一步治疗后分为生存组和死亡组。分别检测治疗前、治疗后1 d、治疗后5 d实验组和对照组中呼出气NO和血清NO的水平,并分析其与APACHEⅡ评分、氧合指数(PaO2/FiO2)、氧分压(PaO2)的相关性以及呼出气NO和血液NO的相关性。结果实验组治疗前的呼出气NO、血清NO显著高于对照组,且经过治疗后呼出气NO、血清NO均显著下降(P<0.05)。在ARDS生存组患者治疗后1 d,APACHEⅡ评分、呼出气NO、血清NO均较治疗前有所下降(P<0.05),氧合指数和氧分压治疗后均有上升,治疗后5 d这些数值变化更明显。但是,在死亡组,随着时间流逝,APACHEⅡ评分、呼出气NO、血清NO均不断增高,氧合指数和氧分压逐渐下降(P<0.05)。ARDS患者呼出气NO、血清NO与APACHEⅡ评分呈正相关,与PaO2/FiO2和PaO2呈负相关(P<0.05)。ARDS患者呼出气NO与血清NO呈显著正相关(P<0.05)。结论呼出气NO的水平可反映ARDS患者缺氧情况及病情的严重程度,有利于疗效评估及预后判断,且方便快捷、无创安全,可替代血清NO检测。

Objective To investigate the application of exhaled NO in the condition evaluation of acute respiratory distress syndrome.Methods 102 patients diagnosed with acute respiratory distress syndrome(ARDS)at the ICU of our hospital from September 2015 to September 2017 were selected as the experimental group,while 22 normal subjects who underwent physical examination at the Outpatient Department were selected as the control group.All cases were screened for inclusion according to the 2012 Berlin criteria.The experimental group was divided into the survival group and the death group after two weeks of further ICU treatment.The levels of exhaled NO and serum NO in the experimental group and control group were detected before treatment,1 d after treatment,and 5 d after treatment,respectively,and the correlation between them and APACHEⅡscore,oxygenation index(PaO2/FiO2)and oxygen partial pressure(PaO2),as well as the correlation between exhaled NO and blood NO was analyzed.Results The exhaled NO and serum NO in the experimental group before treatment was significantly higher than that in the control group,and the exhaled NO and serum NO decreased significantly after treatment(P<0.05).In the ARDS survival group,1d after treatment,APACHEⅡscore,exhaled NO and serum NO all decreased compared with those before treatment(P<0.05),while both oxygenation index and oxygen partial pressure increased after treatment.These changes were more pronounced at 5 d after treatment.However,in the death group,with the passage of time,APACHEⅡscore,exhaled NO and serum NO increased constantly,while oxygenation index and oxygen partial pressure decreased gradually(P<0.05).The exhaled NO and serum NO in patients with ARDS were positively correlated with APACHEⅡscore,and negatively correlated with PaO2/FiO2 and PaO2(P<0.05).There was a significant positive correlation between exhaled NO and serum NO in patients with ARDS(P<0.05).Conclusion The level of exhaled NO can reflect the hypoxia condition and severity of condition in patients with ARDS,which is conducive to the evaluation of efficacy and prognosis,being convenient,fast,non-invasive and safe,and can replace the serum NO test.