利多卡因雾化吸入对急性呼吸窘迫综合征患者支气管肺泡灌洗液SP-A的影响
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摘要
目的：探讨利多卡因雾化吸入对急性呼吸窘迫综合征患者支气管肺泡灌洗液SP-A的影响。方法：22例ARDS患者,机械通气时间大于7天。随机分为两组：利多卡因雾化组(L组)；生理盐水雾化组(N组)。22例ARDS患者入ICU后,予以积极治疗原发病,肺保护通气策略行机械通气治疗,咪唑安定+芬太尼镇静、镇痛,保守的液体管理策略。L组雾化吸入盐酸利多卡因4mg-kg,生理盐水稀释至20ml,N组雾化吸入等容积生理盐水,连续治疗6天。第1、7天行支气管肺泡灌洗,收集支气管肺泡灌洗液,ELISA测定SP-A、TNF-α浓度。监测肺顺应性、氧合指数,并计算肺损伤评分。结果：1、两组患者在年龄、性别、体重、诱发ARDS的原发病分布等一般资料差异无统计学意义；2、与N组比较,第1天L组支气管肺泡灌洗SP-A. TNF-α浓度,肺顺应性,氧合指数,肺损伤评分差异无统计学意义(p>0.05)；与N组比较,第7天L组支气管肺泡灌洗液SP-A浓度较N组高,TNF-α浓度下降,肺顺应性增加,氧合指数升高,肺损伤评分改善,差异具有统计学意义(p<0.05)。结论：利多卡因雾化吸入抑制ARDS患者支气管肺泡灌洗液SP-A浓度下降,进而改善肺顺应性,提高氧合指数及降低肺损伤评分,可能与抑制肺内炎症反应有关。
Objective:To study Effect of inhaled aerosolized lidocaine on surfactant-associated protein-A in bronchoalveolar lavage fluid of ARDS.
Methods:Twenty-two patients suffered from acute respiratory distress syndrome were divided into two groups randomly:Lidocaine group(group I) and normal saline group(groupⅡ). After twenty-two patients were enrolled, We treated primary disease positively. A lung-protective ventilation strategy and a conservative strategy of fluid management should be implemented. Sedation and analgesia were implemented with midazolam and fentanyl. In group I, patients Inhaled aerosolized lidocaine(4mg/kg),which were diluted into 20ml with normal saline. In groupⅡ, patients Inhaled aerosolized normal saline, the volume of which were equal to groupⅠ.All the patients were treated continuously for six days. On the first and seventh day, they were subject to bronchoalveolar lavage. Collect the bronchoalveolar lavage fluid(BALF) and measure the concentration of SPA and TNF-a of BALF. Measure lung compliance、oxygenation index and lung injury score.
Results:There were no significant difference in age、gender、body weight and primary disease which caused ARDS between two groups.There were no significant difference in concentration of SP-A and TNF-a of BALF、lung compliance、oxygenation index and lung injury score on the first day between two groups. The concentration of SP-A and TNF-αof BALF were decreased in group I compared with groupⅡ;Lung compliance and oxygenation index were increased in group I compared with groupⅡ; lung injury score were decreased in group I compared with groupⅡ.
Conclusion:Inhaled aerosolized lidocaine inhibit expression down regulation of SP-A of ARDS, improve Lung compliance and oxygenation index, decrease lung injury score, which were due to inhibit the inflammatory reaction of lung.
Objective:To study Effect of inhaled aerosolized lidocaine on surfactant-associated protein-A in bronchoalveolar lavage fluid of ARDS.
Methods:Twenty-two patients suffered from acute respiratory distress syndrome were divided into two groups randomly:Lidocaine group(group I) and normal saline group(groupⅡ). After twenty-two patients were enrolled, We treated primary disease positively. A lung-protective ventilation strategy and a conservative strategy of fluid management should be implemented. Sedation and analgesia were implemented with midazolam and fentanyl. In group I, patients Inhaled aerosolized lidocaine(4mg/kg),which were diluted into 20ml with normal saline. In groupⅡ, patients Inhaled aerosolized normal saline, the volume of which were equal to groupⅠ.All the patients were treated continuously for six days. On the first and seventh day, they were subject to bronchoalveolar lavage. Collect the bronchoalveolar lavage fluid(BALF) and measure the concentration of SPA and TNF-a of BALF. Measure lung compliance、oxygenation index and lung injury score.
Results:There were no significant difference in age、gender、body weight and primary disease which caused ARDS between two groups.There were no significant difference in concentration of SP-A and TNF-a of BALF、lung compliance、oxygenation index and lung injury score on the first day between two groups. The concentration of SP-A and TNF-αof BALF were decreased in group I compared with groupⅡ;Lung compliance and oxygenation index were increased in group I compared with groupⅡ; lung injury score were decreased in group I compared with groupⅡ.
Conclusion:Inhaled aerosolized lidocaine inhibit expression down regulation of SP-A of ARDS, improve Lung compliance and oxygenation index, decrease lung injury score, which were due to inhibit the inflammatory reaction of lung.
引文
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