全氟化碳对烟雾吸入性损伤患者肺保护作用的临床研究

发布时间：2018-03-07 06:40

本文选题：烟雾吸入性损伤　切入点：全氟化碳　出处：《新乡医学院》2013年硕士论文　论文类型：学位论文

【摘要】：背景烟雾吸入性损伤病死率高,目前无特效疗法。动物实验表明应用全氟化碳(Perfluorocarbon,PFC)可明显改善烟雾吸入性损伤的肺部及全身炎症反应、改善氧合。目的本研究通过对临床上烧伤合并中重度烟雾吸入性损伤患者行气管内分次注入PFC治疗,观察治疗效果、肺部氧合功能及相关炎性介质水平,探讨PFC对烟雾吸入性损伤的肺保护作用,为进一步临床应用提供理论支持。方法 1.符合入选标准的烧伤合并中重度吸入性损伤患者按随机数字分组法分入试验组和对照组。对照组给予抗感染、营养支持、抗休克及对症支持治疗等。试验组在此基础上经气管切开处气管套管给予15mlPFC(1.672g/ml)每12小时一次,共3天。 2.所有入选患者按照急性生理和慢性健康评估(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分标准分别于入院时及治疗3d后评分。患者于治疗前、治疗3d后抽取动脉血气,观察并记录肺动态顺应性、肺泡动脉氧分压差、氧合指数。患者于治疗前及治疗3天后行支气管肺泡灌洗,将回收的支气管肺泡灌洗液(broncho-alveolar lavage fluid,BALF)标本离心后取上清液装EP管于-80℃超低温冰箱内保存；离心沉淀的部分立即行细胞分类计数(中性粒细胞、巨噬细胞)。治疗前及治疗3天后抽取静脉血标本离心后上清液装EP管于-80℃超低温冰箱内保存。用双抗体夹心ELISA法检测定血浆和BALF中炎症介质(TNF-α、IL-8、NF-κB)的浓度。结果 1.烧伤合并中重度烟雾吸入性损伤患者12例入选试验组,11例入选对照组。经治疗后,试验组APACHE Ⅱ评分分值明显下降(P0.05)。 2.与对照组比较,试验组患者的氧合指数升高,但并无显著统计学差异(P0.05)。经治疗3天后两组患者的肺动态顺应性均有所升高、肺泡动脉氧分压差均有所下降,与对照组比较,试验组肺动态顺应性、肺泡动脉氧分压改善明显(P0.05)。 3.经治疗3天后两组患者BALF中中性粒细胞所占比例均降低,巨噬细胞所占比例均升高。以试验组治疗前后进行自身比较,患者BALF中中性粒细胞所占比例明显降低(P0.01),巨噬细胞所占比例明显升高(P0.05)。与对照组比较,试验组BALF中的中性粒细胞所占比例明显降低(P0.01),巨噬细胞所占比例明显升高(P0.05)。 4.与对照组比较,试验组在气管内滴入PFC治疗3天后,BALF中TNF-α的浓度降低,但未见显著统计学差异(P0.05)。以试验组治疗前后进行自身比较,经治疗3天后患者BALF中IL-8、NF-κB的浓度降低明显(P0.05)。 5.经治疗后,试验组与对照组患者血浆中TNF-α、IL-8及NF-κB浓度均未有明显改善。结论 1.气管内滴入PFC治疗烟雾吸入性损伤患者,可明显改善肺泡动脉氧分压差和肺动态顺应性,改善烟雾吸入性损伤患者的肺部气体交换。 2.气管内滴入PFC可使烟雾吸入性损伤的早期肺组织内中性粒细胞的数量明显减少,巨噬细胞数量增加,促进炎症吸收,对早期肺损伤有保护作用。 3.气管内滴入PFC治疗烟雾吸入性损伤患者,可明显减少早期肺泡炎性因子如IL-8、NF-κB的释放,发挥局部抗炎作用。
[Abstract]:background
Smoke inhalation injury has a high mortality rate, and there is no specific treatment at present. Animal experiments show that Perfluorocarbon (PFC) can significantly improve the lung and systemic inflammatory response and improve oxygenation in smoke inhalation injury.
objective
Through the study of clinical burn combined with severe smoke inhalation injury in patients with intratracheal injection of PFC treatment, observe the treatment effect, pulmonary oxygenation function and related inflammatory mediators, to investigate the protective effect of PFC inhalation lung injury of smoke, for further clinical application to provide theoretical support.
Method
1. meet the criteria of burn patients with severe inhalation injury patients were divided into experiment group and control group according to the random number table method. The control group was given anti infection, nutrition support, anti shock and symptomatic treatment. The experimental group on the basis of tracheotomy at the tracheal tube with 15mlPFC (1.672g/ml) every 12 hours, a total of 3 days.
2. of all patients in accordance with acute physiology and chronic health evaluation (acute physiology and chronic health evaluation II, APACHE II) standard for evaluation respectively at admission and after treatment 3D score. The patients before treatment, after treatment of 3D extraction of arterial blood gas, observe and record the dynamic lung compliance, arterial oxygen pressure, oxygenation index. Before treatment and after 3 days in patients underwent bronchoalveolar lavage, bronchoalveolar lavage fluid will be recovered (broncho-alveolar lavage, fluid, BALF) sample was centrifuged and the supernatant was loaded EP tube at -80 deg.c for ultra low temperature refrigerator; centrifugal sedimentation part of the immediate cell count (neutrophils, macrophages) treatment. Before and after 3 days of treatment, blood samples were collected after centrifugation the supernatant containing EP tube at -80 deg.c for ultra low temperature refrigerator. Detection of inflammatory mediators in plasma and BALF with the method of double antibody sandwich ELISA (TNF- The concentration of alpha, IL-8, NF- kappa B).
Result
1. 12 cases of burn combined with moderate and severe smoke inhalation injury were enrolled in the experimental group and 11 cases were enrolled in the control group. After treatment, the score of APACHE II score in the experimental group decreased significantly (P0.05).
2. compared with the control group, the experimental group oxygenation index increased, but no significant difference (P0.05). After 3 days of treatment by dynamic lung compliance of patients in two groups were increased, arterial oxygen partial pressure difference decreased, compared with the control group, the experimental group dynamic lung compliance, Alveolar arterial oxygen partial pressure significantly improved (P0.05).
3. after treatment for 3 days after the two groups of neutrophils in patients with BALF ratio decreased, the proportion of macrophages were increased. Compared to the experimental group before and after treatment, accounted for the proportion of neutrophils in BALF patients were significantly decreased (P0.01), the proportion of macrophages was significantly increased (P0.05) and the control group. For comparison, neutrophil test in group BALF decreased significantly (P0.01), the proportion of macrophages increased significantly (P0.05).
4. compared with the control group, after 3 days of intratracheal instillation of PFC, the concentration of TNF- alpha in BALF decreased, but there was no significant difference (P0.05). In the experimental group, the concentration of IL-8 and NF- NF- B in BALF decreased significantly after 3 days treatment (P0.05).
5. after treatment, the concentrations of TNF- alpha, IL-8 and NF- kappa B in the plasma of the experimental group and the control group were not significantly improved.
conclusion
1. intratracheal instillation of PFC in the treatment of smoke inhalation injury can significantly improve Alveolar arterial oxygen pressure difference and pulmonary dynamic compliance, and improve lung gas exchange in patients with smoke inhalation injury.
2. intratracheal instillation of PFC can reduce the number of neutrophils in the early stage of smoke inhalation injury, increase the number of macrophages, promote the absorption of inflammation, and protect the early lung injury.
3. intratracheal infusion of PFC in patients with smoke inhalation injury can significantly reduce the release of early alveolar inflammatory factors such as IL-8, NF- kappa B, and play a local anti-inflammatory effect.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563

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