急性呼吸窘迫综合征( ARDS) 本身即为呼吸系统的急危重症, 80% 以上ARDS 患者需要气管插管和机械通气 。 凡属严重ARDS 的患者, 均有应用挽救性治疗( rescue therapies) 的适应证。
Objective To evaluate the efficiency and associated factors of noninvasive positive pressure ventilation( NPPV) in the treatment of acute lung injury( ALI) and acute respiratory distress syndrome( ARDS) .Methods Twenty-eight patients who fulfilled the criteria for ALI/ARDS were enrolled in the study. The patients were randomized to receive either noninvasive positive pressure ventilation( NPPV group) or oxygen therapy through a Venturi mask( control group) . All patients were closely observed and evaluated during observation period in order to determine if the patients meet the preset intubation criteria and the associated risk factors. Results The success rate in avoiding intubation in the NPPV group was 66. 7%( 10/15) , which was significantly lower than that in the control group ( 33. 3% vs. 86. 4% , P = 0. 009) . However, there was no significant difference in the mortality between two groups( 7. 7% vs.27. 3% , P =0. 300) . The incidence rates of pulmonary bacteria infection and multiple organ damage were significantly lower in the NPPV success subgroup as compared with the NPPV failure group( 2 /10 vs. 4/5, P =0. 01;1 /10 vs. 3/5, P = 0. 03) . Correlation analysis showed that failure of NPPV was significantly associated with pulmonary bacterial infection and multiple organ damage( r=0. 58, P lt;0. 05; r =0. 53, P lt;0. 05) . Logistic stepwise regression analysis showed that pulmonary bacterial infection was an independent risk factor associated with failure of NPPV( r2 =0. 33, P =0. 024) . In the success subgroup, respiratory rate significantly decreased( 29 ±4 breaths /min vs. 33 ±5 breaths /min, P lt; 0. 05) and PaO2 /FiO2 significantly increased ( 191 ±63 mmHg vs. 147 ±55 mmHg, P lt;0. 05) at the time of 24 hours after NPPV treatment as compared with baseline. There were no significant change after NPPV treatment in heart rate, APACHEⅡ score, pH and PaCO2 ( all P gt;0. 05) . On the other hand in the failure subgroup, after 24 hours NPPV treatment, respiratory rate significantly increased( 40 ±3 breaths /min vs. 33 ±3 breaths /min, P lt;0. 05) and PaO2 /FiO2 showed a tendency to decline( 98 ±16 mmHg vs. 123 ±34 mmHg, P gt; 0. 05) . Conclusions In selected patients, NPPV is an effective and safe intervention for ALI/ARDS with improvement of pulmonary oxygenation and decrease of intubation rate. The results of current study support the use of NPPV in ALI/ARDS as the firstline choice of early intervention with mechanical ventilation.
Objective To explore the effects of lateral position ventilation on lung volume and oxygenation in patients with acute respiratory distress syndrome ( ARDS) . Methods Fourteen patients with ARDS were enrolled. Supine position, lateral position and supine position were successively adopted and continued for one hour respectively. End-expiratory lung volume ( EELV) was measured at the end of each epoch. Effects of different position on gas exchange, lung mechanics and hemodynamics were monitored.Results EELV was increased from ( 1109 ±321) mL to ( 1376 ±381) mL after lateral ventilation ( P lt;0. 05) , and decreased to ( 1143 ±376) mL after the second supine ventilation ( P lt;0. 05) . Compared with initial supine ventilation, there was no significant difference in EELV after the second supine ventilation( P gt;0. 05) . PaO2 /FiO2 was increased from ( 154. 3 ±35. 0) mm Hg to ( 189. 9 ±60. 1) mm Hg after lateral ventilation ( P lt;0. 05) , and increased to ( 209. 2 ±75. 4) mm Hg after the second supine ventilation ( P lt; 0. 05) . Compared with initial supine ventilation, PaO2 /FiO2 was increased greatly after the secondsupine ventilation ( P lt; 0. 01) . There was no significant difference in PaCO2 , lung mechanics and hemodynamics after changing different position. Conclusion Lateral position ventilation can increase EELV and improve oxygenation in patients with ARDS.
ObjectiveTo explore the value of procalcitonin-to-albumin (PAR) in patients with acute respiratory distress syndrome (ARDS).MethodsA retrospective study was carried on patients diagnosed with ARDS from December 2016 to March 2018. The receiver-operating characteristics (ROC) curve was used to identify the cutoff value of PAR. The association of PAR and 28-day mortality was evaluated using univariate and multivariable Cox regression.ResultsIn the final analysis, there were a total of 255 patients included. Of whom 164 (64.3%) was male, 91 (35.7%) was female and the mean age was 52.1±14.5 years old. The 28-day mortality of all the patients was 32.9% (n=84). ROC curve revealed that the cutoff value of PAR was 0.039 (specificity: 0.714, sensitivity: 0.702) and area under the curve was 0.793 (95%CI: 0.735 - 0.850, P<0.001). The following variables were considered for multivariable adjustment: age, body mass index, pneumonia, aspiration, sepsis, surgery, PaO2/FiO2, red blood cell counts and PAR (P<0.01 in univariate analysis). After multivariable analysis, only age (HR: 1.033, 95%CI: 1.009 - 1.059, P=0.008), PaO2/FiO2 (HR: 0.992, 95%CI: 0.985 - 1.000, P=0.044) and PAR (HR: 4.899, 95%CI: 2.148 - 11.174, P<0.001) remained independently associated with 28-day mortality (P<0.05).ConclusionHigh PAR predicts a poor outcome in ARDS patients, therefore it appears to be a prognostic biomarker of outcomes in patients with ARDS.
Objective To explore the pathogenesis of acute respiratory disease syndrome (ARDS) by bioinformatics analysis of neutrophil gene expression profile in order to find new therapeutic targets. Methods The gene expression chips include ARDS patients and healthy volunteers were screened from the Gene Expression Omnibus (GEO) database. The differentially expressed genes were carried out through GEO2R, OmicsBean, STRING, and Cytoscape, then enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Gene and Genomes (KEGG) pathways was conducted to investigate the biological processes involved in ARDS via DAVID website. Results Bioinformatics analysis showed 86 differential genes achieved through the GEO2R website. Eighty-one genes were included in the STRING website for protein interaction analysis. The results of the interaction were further analyzed by Cytoscape software to obtain 11 hub genes: AHSP, ALAS2, CD177, CLEC4D, EPB42, GPR84, HBD, HVCN1, KLF1, SLC4A1, and STOM. GO analysis showed that the differential gene was enriched in the cellular component, especially the integrity of the plasma membrane. KEGG analysis showed that multiple pathways especially the cytokine receptor pathway involved in the pathogenesis of ARDS. Conclusions A variety of genes and pathways have been involved in the pathogenesis of ARDS. Eleven hub genes are screened, which may be involved in the pathogenesis of ARDS and can be used in subsequent studies.
急性肺损伤(acute lung injury,ALI)是临床常见的呼吸系统急危重症,其发病机制复杂,病死率高。肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)是ALI发生、发展过程中非常重要的细胞因子。本文就TNF-α在ALI中的作用和以抗TNF-α为靶点治疗ALI的相关研究进行综述。
ObjectiveTo investigate the clinical signification of plasma interleukin-17 (IL-17) 1evel in patients with acute respiratory distress syndrome (ARDS).MethodsForty-five adult ARDS patients and 22 healthy controls were enrolled in this study. The plasma cytokine levels of IL-17, IL-6 and IL-10 were measured by enzyme linked immunosorbent assay. Meanwhile, the baseline data of demographic and clinical tests including oxygenation index, procalcitonin and brain natriuretic peprtide were collected, the acute physiological and chronic health Ⅱ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score were recorded. The main outcome was defined as hospital mortality within 28-day follow-up.ResultsThe plasma concentration of IL-17, IL-6 were higher in the ARDS patients (P<0.05) compared with the controls and the mean levels of IL-17, IL-6 and the APACHEⅡ score and the SOFA score in the non-survivors was higher than those in the survivors (P<0.05). In particular, there was a significant correlation between the plasma levels of IL-17 and IL-6 (P<0.05). Logistic regression and COX multivariate survival analysis suggested that age and SOFA score may be prognostic factors for ARDS.ConclusionsThe plasma concentration of IL-17 is significantly increased in ARDS patients, and its expression is linearly related to the proinflammatory factor IL-6. Both are important inflammatory markers in the acute phase of ARDS and may be important disease severity and prognostic indicators in addition to age and SOFA score.