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目的探讨机械通气时呼气末正压(PEEP)对细胞炎性因子的影响以及对吸入性肺炎疾病的发展变化是否具有与其他疾病不同的影响。方法将55例动脉血氧饱和度<60 mm Hg(1 mm Hg=0.133 kPa)的患者随机分为两组,实验组25例,起始时间PEEP>8 cm H2O(1 mm Hg=0.098 kPa);对照组20例,起始时间PEEP≤5 cm H2O。检测两组患者气管插管时以及5、10、48 h的血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)以及超敏C-反应蛋白(hs-CRP)水平。结果两组患者的IL-6、TNF-α以及超敏C-反应蛋白各时间段血浆水平对比,在5 h以及10 h两个时间段两组的IL-6水平差异有统计学意义(P<0.05),同样在5 h时间段水平肿瘤坏死因子-α差异有统计学意义(P<0.05),而两组患者的超敏C-反应蛋白在5、10、48 h三个时间段,差异均有统计学意义(P<0.05)。结论在吸入性肺炎机械通气时起始时间使用高PEEP可能会导致血浆内较高IL-6、TNF-α水平和超敏C-反应蛋白有所升高,提示此时高PEEP导致炎性反应趋向更为剧烈。
Objective To investigate the effects of positive end expiratory pressure (PEEP) on cellular inflammatory cytokines during mechanical ventilation and whether the changes of the diseases of aspiration pneumonia have different effects on other diseases. Methods Fifty-five patients with arterial oxygen saturation <60 mm Hg (1 mm Hg = 0.133 kPa) were randomly divided into two groups. The experimental group consisted of 25 patients with PEEP> 8 cm H2O (1 mm Hg = 0.098 kPa) ; Control group of 20 cases, the starting time PEEP ≤ 5 cm H2O. Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) were detected at the time of tracheal intubation and at 5,10,48 h Level. Results Compared with plasma levels of IL-6, TNF-α and high-sensitivity C-reactive protein in two groups, the levels of IL-6 in two groups at 5 and 10 h were significantly different (P <0.05). The level of tumor necrosis factor-α also had statistical significance at 5 h (P <0.05), while the two groups of hypersensitive C-reactive protein in three time periods of 5, 10 and 48 h, The differences were statistically significant (P <0.05). Conclusions The use of high PEEP at the start of mechanical ventilation with aspiration pneumonia may result in elevated plasma levels of IL-6, TNF-α and high-sensitivity C-reactive protein, suggesting that high PEEP may lead to inflammatory reactions Trend is more intense.