儿茶酚胺及其中间代谢产物在ICU神经源性肺水肿发病中的作用

Study of the role of catecholamines and their intermediate metabolites in the pathogenesis of neurogenic pulmonary edema in ICU

目的探究儿茶酚胺及其中间代谢产物在重症监护病房(intensive care unit,ICU)神经源性肺水肿发病中的作用。方法选取2020年1月至2023年12月收治的32例ICU神经源性肺水肿患者的临床资料,设为研究组。另选取同期收治的未发生神经源性肺水肿的ICU患者的临床资料,共32例,设为对照组,对两组患者的临床资料进行回顾性分析。比较两组间血气指标、血流动力学参数情况、相关实验室指标、炎症因子和儿茶酚胺及中间代谢产物的水平的差异。结果与对照组比较,研究组动脉血二氧化碳分压(PaCO_(2))、吸入氧浓度(FiO_(2))、动脉血肺泡氧分压差(A-aDO_(2))、呼吸频率(RR)、肺动脉楔压(PAWP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平、总儿茶酚胺、肾上腺素、甲氧基去甲肾上腺素、甲氧基肾上腺素、去甲肾上腺素均升高,动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))、动脉血肺泡氧分压比值(a/APO_(2))、PaO_(2)/FiO_(2)、干扰素-γ(TNF-γ)均降低(P<0.05),组间中心静脉压(CVP)水平比较差异无统计学意义(P>0.05)。经相关性分析,肾上腺素、去甲肾上腺素、甲氧基肾上腺素、总儿茶酚胺、甲氧基去甲肾上腺素与PaCO_(2)、FiO_(2)、A-aDO_(2)呈正相关,与PaO_(2)、SaO_(2)、a/APO_(2)、PaO_(2)/FiO_(2)呈负相关(P<0.05)。结论儿茶酚胺及其中间代谢产物在ICU神经源性肺水肿患者中显著升高,且与血气指标具有相关性,对其疾病的发生发展具有重要作用。

Objective To explore the role of catecholamine and its intermediate metabolites in the development of neurogenic pulmonary edema in the intensive care unit(ICU).Methods Clinical data were collected from 32 patients diagnosed with neurogenic pulmonary edema in the ICU between January 2020 and December 2023,forming the study group.Another 32 ICU patients from the same period who did not develop neurogenic pulmonary edema were selected as the control group.A retrospective analysis was conducted on the clinical data of both groups,comparing differences in blood gas indices,hemodynamic parameters,relevant laboratory indicators,inflammatory factors,and levels of catecholamines and their intermediate metabolites.Results Compared to the control group,the study group showed significant increases in partial pressure of carbon dioxide in arterial blood(PaCO_(2)),fraction of inspiration O_(2)(FiO_(2)),artery-alveolar oxygen partial pressure gradient(A-aDO_(2)),respiratory rate(RR),pulmonary artery wedge pressure(PAWP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),total catecholamines,epinephrine,metanephrine,normetanephrine,and norepinephrine,while partial pressure of oxygen in arterial blood(PaO_(2)),arterial oxygen saturation(SaO_(2)),arterial/alreolar oxygen tension ratio(a/APO_(2)),PaO_(2)/FiO_(2),and interferon-γ(IFN-γ)were significantly decreased(P<0.05).No significant difference was observed in central venous pressure(CVP)levels between the groups(P>0.05).Correlation analysis indicated that epinephrine,norepinephrine,metanephrine,total catecholamines,and normetanephrine were positively correlated with PaCO_(2),FiO_(2),and A-aDO_(2),and negatively correlated with PaO_(2),SaO_(2),a/APO_(2),and PaO_(2)/FiO_(2)(P<0.05).Conclusion Catecholamines and their intermediate metabolites are significantly elevated in ICU patients with neurogenic pulmonary edema and are correlated with blood gas indices,playing an important role in the occurrence and progression of the disease.